The median GRWR and postperfusion portal vein flow in the RLLS group were 2.3 (1.5-3.1) and 132 mL/100 g liver tissue. The overall, <10 Kg LLS and RLLS recipient operative mortalities were 3%, 22%, and 0%; HAT rates were 1.8%, 11%, and 0%, and PVT rates were 6%, 22%, and 11%, respectively. The single patient with HA thrombosis died, while all the 3 PVTs were successfully treated at re-laparotomy. Mesh was used for abdominal closure only in the patient with GRWR of 4.1. Conclusion: Routine reduction of LLS grafts to GRWR <2.5 provides better size-matched livers for children under 10 Kg, results in a low incidence of serious vascular complications, circumvents the difficulties in abdominal closure, and results in excellent patient and graft survival.