A patient with Budd-Chiari's syndrome of idiopathic etiology, received an emergency liver transplant because of terminal liver insufficiency, including encephalopathy, functional renal failure and progressive deterioration of coagulation. The diagnosis was confirmed by biopsy. The transplanted liver was from a patient with the same blood group and the preserving solution was Euro Collins. No veno-venous by-pass was necessary during operation. Anticoagulation was started from the immediate post-operative stage, as well as triple immunosuppressive therapy with azathioprine, cyclosporine and corticoids. The patient is asymptomatic twenty months after transplantation.