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The dominant feature of this dysfunction is bleeding tendencies, but cirrhotic patients may also exhibit inappropriate clotting and pro\u2010coagulation placing them at risk for thromboembolism. We present a case of perioperative fatal pulmonary embolism in an 8\u2010year\u2010old patient with biliary cirrhosis secondary to drug\u2010induced vanishing bile duct syndrome undergoing a deceased donor liver transplant. The massive pulmonary embolism occurred intra\u2010operatively after reperfusion of the donor liver. Despite the initiation of extracorporeal membrane oxygenation, the postoperative course was complicated by bleeding and the patient expired. This unique case highlights the need for venous thromboembolism prevention by screening and prophylaxis prior to liver transplant in at least a subpopulation of pediatric patients. While the risk of thrombosis postoperatively in pediatrics patients is well known, the preoperative risk is less frequently described and deserves attention and practice changing action.<\/jats:p>","DOI":"10.1111\/petr.14017","type":"journal-article","created":{"date-parts":[[2021,3,27]],"date-time":"2021-03-27T12:05:07Z","timestamp":1616846707000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Perioperative fatal pulmonary embolism in a pediatric liver transplant recipient"],"prefix":"10.1111","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3312-0928","authenticated-orcid":false,"given":"Omar","family":"Jamil","sequence":"first","affiliation":[{"name":"Departments of Internal Medicine and Pediatrics University of Chicago Chicago IL 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