Advances in perioperative care of liver transplant recipients and improvements in treatment of graft rejection and postoperative infectious complications have made liver transplantation the best therapeutic option in patients with end-stage liver transplantation. However, despite these achievements, early postoperative management of liver transplant recipients remains to be one of the most challenging scenarios in the intensive care unit. The burden of the end-stage liver disease and its systemic manifestations such as hepatopulmonary syndrome, hepatorenal syndrome, and cirrhotic cardiomyopathy, the effects of the major surgery itself, and the graft related problems such as hepatic artery thrombosis and acute rejection are the main reasons of this challenge. Furthermore, the facts that recently sicker patients with more comorbidities have undergone liver transplantation and grafts from marginal donors have been extensively used significantly increases the intensive care management of liver transplant recipients.

As sicker patients with multiple comorbidities receive liver transplants from more marginal donors, an appropriate intensive care management becomes even more crucial for decreasing postoperative morbidity and mortality in this group of patients. Meticulous prevention, timely recognition, and immediate treatment of postoperative complications should be the goals of intensivists who are involved in the early postoperative care of liver transplant recipients. A multidisciplinary approach, close monitoring of organ system functions, understanding the pathophysiologic changes in these patients, intensive and collaborative efforts, and a skillful and knowledgeable leadership are the key components for a better overall outcome in liver transplant recipients.