Background: Portal vein thrombosis (PVT) is a surgical challenge in liver transplantation (LTx). Presence of PVT was considered as a contraindication for LTx in some centers due to the controversy revolving around the long term outcome of these patients. Therefore, we studied the long term outcome of adult patients with PVT in LTx in a tertiary institution with specialized transplantation unit. Methods: There were 570 cases of adult liver transplantation between 2004 and 2009 in our institution. We excluded 99 cases of deceased donor liver transplantations to facilitate incidence, outcome and surgical management. There were 56 patients with existing PVT before 471 living donor liver transplantations. Patients with PVT were divided into 2 groups according to Yerdal’s classification, mild PVT group (Yerdel group 1 & 2) 43 cases and severe PVT group (Yerdel group 3 & 4) 13 cases. Results: Patients with PVT constituted 11.8% (n=56) in our cohort. When comparing between patients without and with PVT, we did not find statistical difference in terms of age, gender, Child-Pugh score, MELD score & indication for LTx (benign vs malignancy). Rate of PV complication was 3.4% in the non-PVT group and 8.9% in PVT group (p=0.047). Duration of operation and total amount of blood transfusion were also comparable between two groups. The overall survival of PVT group was not significantly different compared to the non-PVT group (p=0.059). Demographics of 43 cases of mild PVT (76.7%) and 13 cases of severe PVT (23.3%) were not different except in severe PVT group had more malignancy cases (27 cases vs 2 cases, p=0.011). The median overall survival of mild PVT group is comparable with non-PVT group (p=0.059) and the median overall survival of severe PVT group is 32 months (1-88) and non-PVT group is 41 months (1-93) (p=0.066). 5-year survival rate of severe PVT is about 60%. Conclusions: Existing PVT prior to liver transplantation does not lead to poorer long term outcome. However in severe cases, we need more careful approach. Therefore, PVT should not be a