Abstract： Objectives　To sum up the principles and strategies of preoperative preparation for orthotopic liver transplantation (OLT) in patients with hepatic failure. Methods　The relations of preoperative coagulability, the status of the patient, intraoperative bleeding amount to the postoperative recovery of 7 patients with liver failure and 3 cases of non-cirrhotic liver disease were comparatively analyzed. Results　All the 7 cirrhotics had Child-C liver function with a mean platelet count of 28.85×109/L. Their mean prolongation of PT was 10.1 seconds with mean APTT prolongation of 27.8 seconds as compared with controls. Mean fibrenogen in the blood was only 1.5!g/L; and the 3 non-cirrhotic liver disease patients had child-B to child-A liver function with nomal PT, APTT, fibrenogen level and unmarkedly decreased platelet count. All the 7 cirrohtics experienced diuretic and support treatment and had blood infusion of 571!ml, albumin of 57!g, frozen fresh plasma of 300 ml, platelet of 1.1×1011, cryoprecipitate of 1.4 units, lyophilized prothrombin complex concentrate of 1 000 units and fibrinogen of 2.0!g; nevertheless the 3 patients wiht non-cirrhotic liver disease did not received coagulation factors, frozen fresh plasma and diuretics but a little blood and albumin. Intraoperative mean bleeding of the 7 cirrhotics was 8 455!ml, in addition to equivalent blood, albumin of 88.5!g and frozen fresh plasma of 957.1!ml were infused. However, the albumin level was only 26.1!g/L at the end of operation with markedly disturbance of internal milieu within 48!h of postoperative course, and 5 cases of fungal infection, and 3 cases of intraabdominal bleeding within one month. The 3 patients with non-cirrhotic liver disease had intraoperative bleeding of 2 660!ml and received equivalent blood and a little albumin and had a albumin level of 30.7!g/L and unmarked internal milieu disturbance at the end of operation and no infection and bleeding into the abdomen occurred. Conclusions　In the patients with hepatic failure undergoing OLT, full correction of coagulopathy, hypoalbuminemia, anemia and internal milieu disturbance is an important factor to ensure an uneventful operation and postoperative course.