Orthotopic liver transplantation (OTLT) for children with end stage liver failure has doubled 1-year survival rates to over 70% with the employment of cyclosporine and prednisone in conjunction with skilled surgical and medical specialists providing supportive care. The otolaryngology service has assisted in the care of 18 of 61 children undergoing OTLT, particularly in managing respiratory problems that required improved pulmonary toilet and prolonged intubation. The prevention of atelectasis of the lung and subsequent sepsis appears to be improved by prompt bronchoscopy.