Orthotopic liver transplantation (OLT) has historically been associated with massive blood loss and transfusion. This study evaluated the factors associated with blood loss and blood product requirement in patients who were operated with piggyback technique. The medical records of all OLT patients performed between March, 10, 2002 and May, 21, 2008 was reviewed. Primary outcomes included intraoperative blood loss as recorded by the anesthesiologist and use of blood products. There were 261 liver transplants performed during 6 years study period (66% male, mean recipient age 38.8 y/o). Mean blood loss was 3558mL and mean transfusion requirement was 5.4 units packed cell(PC), 2.6 units FFP & 1.7 units platelets. 25(9%) recipients required more than ten units and 7 recipients (2.7%) required no packed cells intraoperatively. Laboratory values associated with increasing estimated blood loss include: lower starting hemoglobin, higher starting INR, lower starting platelet count, higher initial central venous pressure (CVP) and increasing total anesthesia time. The amount of blood loss increased with male gender and older age. FFP and platelet use was increased in a manner similar to blood loss and PC usage for laboratory values, initial CVP and anesthesia time. Correlation test between data and blood loss revealed a decrease in blood loss with the passage of time (P<0.05). The major factors predicting the usage of blood products were initial INR, platelet count, hemoglobin and older age. Improvement in the experience of the team has a dramatic role in decreasing blood loss and blood products transfusion.