A complex liver transplantation is defined as a procedure in which recipient hepatectomy and/or graft implantation is anticipated to be technically difficult. Piggyback total hepatectomy technique may be completely changed to total hepatectomy including the inferior vena cava resection because of technical complexity caused by the hypertrophied caudate lobe, severe inflammatory adhesion, and enlarged venous collaterals caused by portal hypertension. The use of veno-venous bypass may be necessary. Sclerosing encapsulating peritonitis, portal vein thrombosis, polycystic liver disease, and the presence of a previous bilio-enteric anastomosis or liver retransplantation are factors that increase the surgical difficulty.