Living-donor liver transplant with a left lateral segment for small pediatric patients is a well-accepted procedure; however, the size of the graft may be too large, especially for children weighing less than 10 kg and aged younger than 1 year. In this study, we evaluate our experience with left lateral segment liver graft. Since September 2001, 111 liver transplants have been done in 108 children at our center. Living-donor liver transplant was done using the donor’s left lateral segment in 65 children. Children were divided into 2 groups: group 1 consisted of 33 children who had graft-to-recipient weight ratios less than 3%, and group 2 consisted of 32 children who had graft-to-recipient weight ratios of 3% or more. Results: The median weights of the children in groups 1 and 2 were 1.2 kg. The median graft-to-recipient weight ratios in groups 6.6 kg and 7.618.5 0.8. Postoperative complications, acute rejection 0.6 and 4.11 and 2 were 1.9 rates, and graft and patient survival rates were similar in both groups. Delayed abdominal closure was required in 1 child in each group. None of children required mechanical ventilation postoperatively. Daily Doppler ultrasonographic evaluations show no size-related graft perfusion problems. During a mean 20.4 months, 8 children died (5 in group 1 and 3 in group 2). Follow-up of 29.6 The remaining 57 children (90.4%) are alive at the time of this writing with good graft functioning. Left lateral segment living-donor liver transplant is feasible for small babies with liver failure who weigh less than 10 kg and are aged younger than 1 year. Grafts with graft-to-recipient weight ratios larger than 3% may be used safely in children. This is significant clinically because it decreases the unnecessary need to reduce graft size, which may be time consuming and can lead to complications.