Abstract： Objective To present our clinical outcomes of adult-to-children living donor liver transplantation(A-CLDLT) and summarize our experience. Methods The clinical data, preoperative assessment, surgical strategies and complications of 42 adult donors and children recipients who underwent A-CLDLT from April 2006 to December 2009 in Children's Hospital of Chongqing Medical University were retrospectively analyzed. These 42 recipients (21 boys and 21 girls) aged from 80 days to 14 years whose body weight at the time of operation was 3. 08 to 45. 00 kg. In all the children recipients, 28 cases suffered biliary atresia, 6 Wilson' s diseases, 4 glycogen storage diseases, 3 cavernous transformation of the portal vein, and 1 fulminant hepatitis. All recipients were followed up from 2 to 43 months. Results The living donors were 24 mothers, 12 fathers, 4 grandmothers, 1 elder brother and 1 uncle with ABO compatible with the children recipients. Thirty-one left lateral lobes, Ⅰ segment Ⅱ, 8 left lobes without middle hepatic vein (MHV) and 2 right lobes without MHV were obtained. Average hospital length was 9. 8 days for the donor group without any complications except one donor suffered from postoperative bile leakage. Postoperative immunosuppression included prednisone, Tac, cyclosporine and mycophenolate mofetil Thirty-six postoperative complications occurred in 32 recipients (76. 2 %,), and 5 died from postoperative complications including 4 postoperative vascular complications and 1 Aspergillus pulmonary infection. The perioperative mortality rate of recipients was 11.9 % (5/42). During follow-up term, 9 suffered from complications and 4 died including 1 case of hemophagocytic syndrome and 3 cases of stricture of hepatic vein. In addition, 2 recipients died of accidental asphyxia and food poisoning during follow-up term. The longest survival time was 43 months. At present, 31 recipients were survival (73. 8 %). Conclusion A-CLDLT has become an effective method to children with end-stage liver disease. The postoperative vascular complications are the predominant cause of death. Prevention and therapy of the vascular complications are extremely helpful to raise the survival rate of A-CLDLT.