Orthotopic liver transplantation (OLT) involves significant changes in intravascular blood volume and proper hemodynamic monitoring is vital. The pulse contour cardiac output (PiCCO) system is a relatively new device based on the single-indicator transpulmonary dilution technique. It provides intermittent cardiac index (CI) assessment, continuous CI measurements by pulse contour analysis, and an estimation of preload as the intrathoracic blood volume index (ITBVI) and the extravascular lung water index (EVLWI). The aim of this retrospective study was to analyze one center’s experience with this monitoring system in patients undergoing OLT. The charts of 20 patients who underwent OLT at Baskent University Hospital between January and July 2004 were reviewed. The subjects were divided into two groups: Group I (n=10) had hemodynamics assessed with the PiCCO system, whereas standard monitoring was used in Group II (n=10). The hemodynamic and volumetric variables (CI, mean arterial pressure (MAP), central venous pressure (CVP), ITBVI, EVLWI and PaO2/FiO2) were recorded during three phases: after induction of anesthesia, during the anhepatic phase and at the end of surgery. Demographic data, intraoperative amount of fluids administered and intra-and postoperative urinary outputs were also recorded for each subject. The primary outcome was to compare the durations of mechanical ventilation, length of ICU and hospital stay, need for inotropic support and transfusion and postoperative complications between the groups. The groups’ demographic characteristics regarding age, weight, height, and cold ischemia time were similar. There were no significant differences with respect to inotrope requirements, amounts of blood salvaged, intraoperative fluids and blood administered (p>0.05 for all). In Group I there was a trend towards increased urinary output postoperatively (p=0.072). Groups I and II had similar mean anesthesia and extubation times (9.6 ± 2.3 vs 9.9 ± 2.7 hrs and 9.7 ± 13.4 vs 2 ± 3.6 hrs respectively). The groups’ postoperative complication rates, lengths of ICU and hospital stays were similar as well (p>0.05 for all). Hemodynamic monitoring with the PiCCO system seems to provide an effective way to optimize volume management and vasoactive drug administration particularly during anesthesia for OLT. However, these results should be confirmed with larger case series.