Due to the scarcity of donor livers, living liver transplantation has been further developed in recent years and has gained acceptance as a life-saving treatment. However, living liver transplantation is a very complex therapeutic measure, especially the application of living liver transplantation in adults, which involves transplantation, surgery, hepatology, psychiatry and ethics. At present, the initial results are satisfactory. Therefore, only a better understanding of living liver transplantation can provide the best option for patients with advanced liver disease. This article presents a review and outlook of recent experience in donor-recipient selection, improvements in surgical techniques, donor-recipient complications and outcomes, and problems in adult living liver transplantation. Living liver transplantation is characterized by the fact that there is no need to wait for a donor liver, so the timing of surgery depends on the surgeon’s judgment of the recipient’s condition. This greatly reduces the morbidity and mortality of the recipient while waiting for a donor liver. Secondly, the donor liver is from a healthy individual who has undergone a careful preoperative evaluation, and the quality of the donor liver is good with a short cold ischemia time. There are still no clear indications for living liver transplantation, and many centers select patients based on their own experience. However, the patient must meet the minimum criteria for cadaveric liver transplantation as defined by UNOS, which is generally a Child2Pugh score of >10 or a small liver cancer (Status 2B). Many centers do not use living donor livers for patients with Status 2A requiring ICU admission, mainly because of the high morbidity and mortality rates and complications following living donor liver transplantation in this group of patients; Testa et al. reported a 57% morbidity and mortality rate for patients with Status 2A at 15-month follow-up with living donor liver transplantation, which was much lower than the 18% rate for cadaveric liver transplantation. Therefore, the routine use of living donor livers in patients with Status 2A is considered by most to be inappropriate. Some centers believe that these patients can wait and do not require emergency living donor liver transplantation, while others believe that these patients have a good outcome after early transplantation. Current UNOS statistics indicate that the preoperative grading of living liver transplant recipients is 12% for Status 1, 2% for 2A, 49% for 2B, and 37% for 3. Therefore, the best indication is for patients with Status 2B and Status 3. For patients with acute liver failure in Status 1, the morbidity and mortality rate of acute liver failure is high, and failure to perform transplantation in a timely manner can lead to further cerebral edema and secondary infection. Theoretically, living liver transplantation is the most suitable treatment for acute liver failure, and successful treatment of Status 1 with living liver transplantation has been reported. Although the 1-year survival rate is only 60-70%, it is still a life-saving treatment. However, it is still a life-saving option. The indications for living liver transplantation have evolved with clinical advances. In terms of disease type, early living liver transplantation was used to treat congenital and metabolic disorders in children, such as congenital biliary atresia and Wilson’s disease. With the use of living liver transplantation in adults, the indications for living liver transplantation have been expanded to include end-stage liver disease due to hepatitis cirrhosis. Currently, about 2/3 of adult living liver transplants in Hong Kong, China and Korea are for patients with end-stage liver disease caused by hepatitis B cirrhosis. With the establishment of the Milan Criteria, UONS has included patients with liver cancer < 5 cm in diameter without distant metastases as an indication for liver transplantation with some preference for the same condition. Therefore, living liver transplantation is also an option for patients with liver cancer. Compared to cadaveric liver transplantation, living liver transplantation allows early surgery at the elective stage without increasing the tumor load and causing distant metastases while waiting for a donor liver. In contrast, the Kyoto group in Japan has performed living liver transplantation for progressive hepatocellular carcinoma without extrahepatic metastases and imaging confirmed no vascular infiltration, and the postoperative recurrence rate was not higher than that of the small hepatocellular carcinoma group, but the long-term results await further follow-up.