A 41-year-old male, weighing 76 kg, diagnosed with ethanol-related chronic liver disease with treated pulmonary tuberculosis was posted for living donor liver transplantation. He had history of pulmonary tuberculosis 6 months ago. The patient also had a history of ascites for which he was on tablet furosemide 80 mg/day and tablet metoprolol 25 mg. He had an Model for End stage Liver Disease (MELD) score of 30. Chest X-ray showed mild pleural effusion of the right side. Bubble contrast ECHO showed moderate shunting with room air PAO2 of 61 mmHg. On the day of the surgery, the patient was taken inside the operation theater. All standard American Society of Anaesthesiologists (ASA) monitors were attached. An 18-G intravenous cannula was secured in the left upper limb. General anesthesia was induced with inj. propofol 100 mg i.v., inj. fentanyl 100 mug i.v., and inj. rocuronium 100 mg i.v. Trachea was intubated with 8.5 Endotracheal Tube (ETT) and the patient was put on mechanical ventilation. Ultrasound-guided one 8.5-F four-lumen central line and one 9-F triple-lumen advanced vascular access sheath were secured in the right internal jugular vein. Two 20-G arterial cannula were secured, one each in radial artery. Fluid warmer, forced air warmer, and heating mattress were used to maintain normothermia in the patient. Anesthesia was maintained with oxygen and air (50:50), isoflurane, 1.5 mug/kg/h fentanyl infusion, and 0.5 mg/kg/hatracurium infusion. After opening the abdomen, dense adhesions with encapsulation of liver and bowel were found [Figure 1]. Along with this, multiple collaterals in hepatoduodenal ligament, perigastric region, pericholedochal, peri-gall bladder, and perimesentric were also present. This resulted in blood loss of 12.5 L in the dissection phase which was replaced with transfusion of 35 units of Packed Red Blood Cells (PRBCs), 15 units of cryoprecipitate, 15 units of Fresh Frozen Plasma (FFP), and 3 single-donor platelet concentrate; 24 L of plasmalyte and 2.25 L of albumin were also given. Noradrenaline and vasopressin were titrated intraoperatively to maintain a minimum mean arterial pressure of 60 mmHg. Warm ischemia time was 29 min, and the cold ischemia time was 1 h 36 min. The rest of the surgery went uneventful with mild post-reperfusion syndrome which was managed with 400 mug bolus of phenylephrine. The patient was shifted to the intensive care unit for elective mechanical ventilation with vasopressor support of noradrenaline 8 mug/min and vasopressin 1 unit/h. The liver functions started improving in the immediate postoperative period indicated by decreasing lactate levels, prothrombin time, International Normalized Ratio (INR), bilirubin, Aspartate Transaminase (AST), and (ALT) Alanine transaminases levels with good portal vein flow and hepatic artery flow on Doppler. The patient was successfully extubated on the second postoperative day despite massive transfusion and shifted out of the intensive care unit on the sixth postoperative day.