Acute liver failure is a rare and serious clinical condition in pediatric population. Despite many developments and multidisiplinary intensive treatment, it has up to 80% mortality rate. Except for a few patients who recover with supportive medical treatment with plasmapheresis, the only curative treatment for hepatic failure is liver transplantation. The situation is a serious health problem especially for the countries that has limited options for transplantation because of cadaveric organ shortage. In this study, 5 pediatric patients (ages; 1.8, 10, 12, 14 and 17 years) with fulminant hepatic failure was investigated, whom were treated with urgent living related liver transplantations in the last 2 years period. The etiologies of the fulminant hepatic failures were; virus related in 3 (1 HAV, 1 HBV+Leflunomide toxicity and 1 non-A non-B virus), Wilson’s disease in 1 and mushroom toxicity in 1 patient. While preparing the patients and the donor candidates for a possible urgent liver transplantation, all patients underwent low flow rate plasmapheresis with 20% human albumine and/or fresh frozen plasma and supportive treatment for the liver. Four patients recovered well after transplantation with excellent graft functions and remained normal during their follow-up in 0.5, 1.1, 1.5 and 26.0 post-transplantation months. One patient with fulminant HAV infection whom had to be entubated prior to transplantation could not be extubated after the operation and died as a result of ARDS in 44th post-transplantation day with excellent graft function. Low flow rate plasmapheresis with 20% albumine and/or fresh frozen plasma and supportive treatment in well equipped ICU, allows selective clearence of bilirubine and eliminate the soluble and albumine bounded toxins from the plasma. This treatment supplies time to the hepatocytes for regenaration and the patients who have enough reserve could be treated with clinical improvement on patients’ condition, getting better coagulation parameters and decreasing bilirubine levels. In the circumstance of insufficient hepatocyte regenerations, the final diagnosis is done with percutaneous neddle biopsy of the liver. Demonstrating the massive necrosis necessitates a liver transplantation as soon as possible, before irreversible brain and other vital organ damages are developed. The patients with fulminant hepatic failure should allways be investigated in well developed transplantation centers, especially experienced in living related pediatric liver transplantations and which has experienced ICU teams and liver support systems.