：Objective To present ourclinical outcomes of adult-to-children living donor liver transplantation(A-CLDLT) andsummarize our experience. Methods The clinical data, preoperative assessment, surgicalstrategies and complications of 42 adult donors and children recipients who underwentA-CLDLT from April 2006 to December 2009 in Children's Hospital of Chongqing MedicalUniversity were retrospectively analyzed. These 42 recipients (21 boys and 21 girls) agedfrom 80 days to 14 years whose body weight at the time of operation was 3. 08 to 45. 00kg. In all the children recipients, 28 cases suffered biliary atresia, 6 Wilson' sdiseases, 4 glycogen storage diseases, 3 cavernous transformation of the portal vein, and1 fulminant hepatitis. All recipients were followed up from 2 to 43 months. Results Theliving donors were 24 mothers, 12 fathers, 4 grandmothers, 1 elder brother and 1 unclewith ABO compatible with the children recipients. Thirty-one left lateral lobes, Ⅰ segment Ⅱ, 8 left lobes without middle hepatic vein (MHV) and 2right lobes without MHV were obtained. Average hospital length was 9. 8 days for the donorgroup without any complications except one donor suffered from postoperative bile leakage.Postoperative immunosuppression included prednisone, Tac, cyclosporine and mycophenolatemofetil Thirty-six postoperative complications occurred in 32 recipients (76. 2 %,), and 5died from postoperative complications including 4 postoperative vascular complications and1 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 caseof hemophagocytic syndrome and 3 cases of stricture of hepatic vein. In addition, 2recipients died of accidental asphyxia and food poisoning during follow-up term. Thelongest 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 liverdisease. The postoperative vascular complications are the predominant cause of death.Prevention and therapy of the vascular complications are extremely helpful to raise thesurvival rate of A-CLDLT.