Orthotopic liver transplantation remains a major medical and surgical challenge in small pediatric patients. From April 2003 to June 2006, 21 small babies (each of whom weighed less than 10 kg or was under the age of 1 month) underwent orthotopic liver transplantation at the Baskent University Hospital in Ankara, Turkey. Five were girls and 17 were boys with a mean age of 15.7±9.3 months (range, 2-24 months); mean weight at the time of transplantation was 9.8±3.6 kg (range, 6-16 kg). All transplants were obtained from a living-related donor. Twenty left lateral segments and 1 left lobe were transplanted. The median graft-to-recipient weight ratio was 3.5%±1.2% (range, 1.5% - 6.1%). During the early postoperative period, hepatic arterial thrombosis was identified in 4 patients, and a biliary leak was detected in 2 patients. In 1 patient, portal vein stenosis, which was identified during the late postoperative period. At the time of this writing, 17 patients (81%) are alive and have exhibited good graft function during a median follow-up of 14.8±10.9 months (range, 1-39 months). Four patients died during the follow-up period. Histologic examination revealed hepatocellular carcinoma in 2 patients, and Burkitt’s lymphoma was diagnosed in 1 patient during follow-up. In conclusion, our data confirm that the use of living-related donors, especially in this age group, provides a reliable source to the organ pool, and satisfactory results can be achieved despite the anatomic handicaps of this age group.