Optimum graft function after liver transplantation is dependent on adequate sinusoidal perfusion. Hepatic microcirculation may be compromised by sev- eral factors such as cold ischemia, quality of the liver graft, handling of the organ during surgery, surgical procedure, and reperfusion injury. This chapter will focus on the pathological consequences of cold preservation and reperfu- sion injury on hepatic microcirculation. Microcirculatory dysfunction in grafts donated after cardiac death as well as steatotic grafts will be under- lined. We will summarize the effects of graft manipulation and denervation during surgery. Furthermore, we will discuss the contribution of microcircu- latory failure to graft rejection. Finally, recent advances in visualization and assessment of human hepatic microcirculation will be highlighted.