A critical shortage of cadaveric livers and an increasing population on the waiting list have encouraged the development of living donor liver transplantation. Living donor liver transplantation accounts for approximately 10% of all liver transplants being performed. One problem unique to lobar transplantation relates to hepatic congestion and associated functional impairment of the transplanted lobe. This congestion is multifactorial and includes low graft-weight ratio, middle hepatic vein drainage problems, and excessive portal venous inflow. Increasing disparities of graft-weight ratios exaggerate the importance of the other two factors. Finally, animal data from asplanchnic and anhepatic models implicate the intestine as the source of tumor necrosis factor released into the circulation following portal unclamping. Tumor necrosis factor, in turn, leads to adhesion molecule upregulation and endothelial cell disruption and potentiates allograft dysfunction. Although veno-venous bypass may alleviate some of these problems, it does not prevent excessive mesenteric venous flows, nor does it prevent the tumor necrosis factor production associated with portal clamping during the portal anastomotic phase. We have recently developed the technique of temporary left portahepatic shunt. This allows portasystemic decompression during implantation and diverts mesenteric blood from the liver during the crucial period after unclamping. Early lobar congestion can be avoided, and the shunt may be left in place for as long as 2 hours while volume homeostasis is restored. This technique allows the tailoring of the portal flow to the graft size to avoid any liver congestion or dysfunction.