Patients undergoing liver transplantation (LT) require early detection and timely correction of coagulopathy to prevent exacerbation of bleeding diathesis and to break the cycle of coagulopathy. Rotation thromboelastometry (ROTEM) is a pointof-care coagulation monitoring system that evaluates the viscoelasticity of whole blood and provides the earliest parameter of clot amplitudes at 5 and 10 minutes (A5, A10) after clotting time. This retrospective study was undertaken to evaluate whether A5 on ROTEM analysis (ROTEM delta; TEM International GmbH, Munich, Germany) correlates with platelet (PLT) count and fibrinogen (Fib) concentration and can predict thrombocytopenia and hypofibrinogenemia in hypocoagulable patients undergoing living-donor LT (LDLT). Of 401 patients who had LT, 239 undergoing LDLT were included. Anesthesia was performed based on the institution’s standard protocol. Transfusions were administered to maintain prothrombin time of less than 2.0 international normalized ratio (INR), Fib concentration greater than 100 mg/dL, and PLT count greater than 30,000/μL. During LDLT, coagulation assays and ROTEM test were performed using blood sample obtained 1 hour after induction of general anesthesia, 1 hour after surgical incision, 30 minutes after hepatectomy, and 30 minutes after graft reperfusion and after hepatic artery anastomosis. The study included 1139 EXTEM, 1182 INTEM, and 1125 FIBTEM tests. ROTEM variables were clotting time, clot formation time, maximum clot firmness (MCF), α angle, and A5 and A10. The correlations between A5 and MCF index, PLT count, and Fib concentration were calculated. Receiver operating characteristic analysis with area under the curve (AUC) was used to determine A5 thresholds predictive of PLT counts of less than 30,000/μL, less than 50,000/μL, and Fib concentrations less than 100 mg/dL. All statistical analyses were done with MedCalc statistical software (MedCalc Software, Mariakerke, Belgium). A 2-tailed P < 0.05 indicated statistical significance. During LDLT, the median PLT count was 47,000/μL (interquartile range [IQR], 32,000–65,000/μL); the median Fib concentration was 100 mg/dL (IQR, 77–137 mg/dL), and the median prothrombin time was 1.8 INR (IQR, 1.6–2.2 INR). Among the ROTEM parameters, A5EXTEM (r = 0.961, P < 0.0001) and A10EXTEM (r = 0.975, P < 0.0001) were highly correlated with