Abstract Background Liver transplantation (OLT) in the setting of portal vein thrombosis (PVT) has been a matter of controversy in the past. We herein report our experience with OLT for PVT in the absence of hepatocellular carcinoma. Patients and Methods Data from patients undergoing OLT for end-stage liver disease, having a documented PVT before OLT, were reviewed. Results Twenty-five patients were included for the period July, 2003 to December, 2009. There were 20 men and 5 women of median age 57 years. Median values for waiting time and Model for End-Stage Liver Disease score were 150 days and 18, respectively. PVT was classified as grade II ( n = 6), IIIa ( n = 7), IIIb ( n = 9), or IVa ( n = 3). Partial portal vein resection/reconstruction, operative thrombectomy, and eversion thromboendovenectomy were performed in 2, 16, and 7 instances, respectively. After a median follow-up of 18 months, 14 patients are alive. Survival rates at 3, 6, 9, and 12, months and 3 years post-OLT were 68%, 64%, 61%, 61%, and 61%, respectively. PVT grade was a negative predictor of survival by Cox proportional hazard analysis ( P = .0253). Conclusion Despite the technical innovations in recent years, PVT grade correlated with poor patient survival irrespective of the surgical technique.