The influence of lymphocytotoxic cross-match on survival or acute rejection in living donor liver transplantation (LDLT) has not been well examined. We analyzed 133 consecutive adult LDLT cases and assessed patient survival and acute rejection rates. Patients with a positive T lymphocytotoxic cross-match (n = 12) had a significantly higher chance of rejection within 6 weeks of LDLT (67% versus 28%, P <.001). All of the rejection episodes were successfully treated with bolus methylprednisolone therapy or anti-T cell monoclonal antibody. T lymphocytotoxic cross-match-positive grafts had no influence on patient survival (79% versus 90% at 3 years, P =.91). The results show that a positive cross-match graft should not be considered a contraindication for LDLT.