We have 3 more cases of experiences of massive transfusion undergoing hepatobiliary surgery above 20 units of whole blood, packed RBCs, FFP or cryoprecipitate under thrombelastographic guidance and monitoring intraoperatively. One of them had been transfused with 98 units of whole blood and 16 units of PRBC during a couple of times operation without any post-massive transfused pulmonary complications. TEG was originally developed by Hartert in 1948 but its clinical use has been limited. Recently as increases of severe and persistent coagulopathy that accompanies end-stage liver diseases and leads to massive intraoperatve bleeding, minute-to-minute monitoring of the coagulation system is mandatory for successful completion of surgery and for patient survival. Under the condition of our clinical experiences TEG appears to be a very effective method of monitoring blood coagulation. First, blood coagulabilty can be observed rapidly and simply in acute clinical situations within 30 minutes. Second, it assesses the quality of blood clot including the influence of cellular and humoral elements and pathologic conditions. The last, under the reliable guidance of TEG we could facilitate the segmental blood transfusion rather than using whole blood intraoperatively and it is to be a moment of the development of PRBC transfusion set by Kim et al.