Liver transplantation (LT) has been widely performed as an effective approach to treat end-stage liver diseases. Platelet transfusion may be required in the presence of perioperative thrombocytopenia, coagulopathy and blood loss during surgery. In addition to hemostasis, platelets also mediate ischemia reperfusion injury through interaction with leukocytes and Kupffer cells, and participate in tissue repair and regeneration through secreting various cytokines. However, it is still under discussion that whether platelet transfusion can affect the survival of LT recipients. In fact, the dramatic changes in platelet count and function, and the re-balance between pro-coagulant and anti-coagulant factors require more accurate measurement of coagulation condition during LT. Thromboelastography (TEG) can monitor the changes of clot formation as a whole and facilitate decision-making in platelet transfusion. Therefore, the functions of platelets should be comprehesively consided, and rational use of platelets under TEG/ROTEM is suggested.