The only proven therapy for patients unlikely to recover from acute liver failure(ALF) is liver transplantation. Therefore, recognition of the condition and urgent referral to a transplant center are critical. In this study, we evaluated 12 pediatric ALF patients who had undergone liver transplantation (LT) at a single center during a 4-year period. Seven patients were female, and 5 were male, and the mean age of the patients was 9.1 ± 4.2 years. Three patients received right liver lobe grafts; 1 received a whole liver graft; and the remainder received left or left lateral lobe grafts. All of the patients recovered from hepatic coma the day after transplantation. Overall, 2 patients died on the 57th and 71st postoperative days. One patient required retransplantation because of chronic rejection 7 months after having undergone the initial transplantation; that patient died due to sepsis 10 days after the retransplantation. As of this writing, the remaining 9 patients are healthy at between 2 and 46months’ follow-up. Today, 75% percent of our patients are alive. Living-donor LT is the only option for ALF patients in countries where organ donation rates are low. In such scenarios, donor preparation in a limited time is crucial, and we have been able to decrease this time interval to approximately 4 hours (including liver biopsy of the donor). In conclusion, at our center, cadaver donation rates are limited; however, in patients with ALF, an LDLT program has been developed that achieves success rates similar to those seen with cadaveric liver transplantation.