[Abstract] Objective The aim of this study was to evaluate the protective effect of remote ischemic preconditioning (RIPC) on graft function and clinical outcomes of pediatric patients with biliary atresia after living donor liver transplantation. Methods Ninety recipients undergoing living donor liver transplantation were randomized to RIPC or Control group. RIPC was induced through three 5 min cycles of alternate ischemia and reperfusion of the right leg prior to surgery. Graft function was assessed through evaluation of the serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) before surgery and at 1h, 1d and 3d after surgery. In addition, the incidences of acute cellular rejection, need of re-transplantation, and major complications; the length of stay in the intensive care unit, and the length of hospital stay; and the 1-year mortality were also investigated. Results No differences in ALT and AST levels at abovementioned timepoint were observed between the groups. Recipients in the preconditioning group spent shorter time in ICU postoperatively and in hospital, although this was not statistically significant. No other clinical benefits with respect to the complication rate, or short-term mortality were observed. Conclusions This study has not demonstrated evidence of a protective effects of RIPC on short-term measures of ischemia/reperfusion injury after liver transplantation. Longer follow up, detection of more sensitive makers and an altered preconditioning protocol will be required to determine the clinical efficacy of RIPC in this scenario.