Introduction <p>Preventing bleeding during the perioperative period is critically important in liver surgery and mismanagement can raise the need for transfusions as well as the rates of morbidity and death. Tranexamic acid (TXA) has been shown to effectively decrease perioperative bleeding in patients with trauma, some studies have also shown that TXA plays the same role in liver surgery. The effectiveness of TXA in hepatectomy and liver transplantation was reassessed in this meta-analysis of randomized controlled trials, which included recently published studies.</p> Methods <p>The PubMed, Web of Science, and Embase databases were comprehensively searched to identify studies that were published from January 1947 to September 2024. Results related to transfusion requirements, incidents of thromboembolism, and the number of deaths were retrieved from the included studies. The data were quantified using random effects models.</p> Results <p>A total of 1674 patients were included in the seven studies. The results showed no discernible difference between the TXA and control groups regarding the reduction in perioperative transfusion needs (OR 0.24; 95% CI 0.03 ~ 1.87) and the final mortality rate (OR 0.99; 95% CI 0.48 ~ 2.06) during hepatectomy and transplantation, however, TXA increased the incidence of thromboembolism (OR 1.74; 95% CI 1.01 ~ 3.01).</p> Conclusions <p>TXA does not reduce perioperative transfusion requirements during liver resection and transplantation and has no significant effect on the final mortality rate; however, TXA does increase the incidence of thromboembolic events.</p>