The shortage of pediatric donor livers has stimulated the development of advanced surgical approaches such as partial liver transplantation, which produces the same results as whole organ replacement. Differences in body weight between donor and recipient of more than four times, however, usually necessitate extended reduction hepatectomy and modified ways of performing vascular reconstruction. Therefore, following ex vivo "trisegmentectomy," a new technique of hepatic venous drainage was developed with an end-to-side anastomosis of the left donor hepatic vein to the preserved recipient inferior vena cava. This operative technique was applied to four children, one of whom had a retransplantation performed in exactly the same fashion. There were no specific complications related to this particular surgical technique. From our preliminary experience we conclude that reduced-size liver transplantation can be safely performed with the described type of hepatic vein reconstruction, especially when large donor organs have to be used for small children.