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Abstract: Aim: This study aimed to assess the effect of Mg2+ therapy in improving ROTEM and total blood products requirement during liver transplantation. Patients and method: The study includes 30 patients suffering from end-stage liver disease with MELD (model for end-stage liver disease) classification ranging from 15 to 24. The patients were divided into two equal groups: Group I: The patients were given placebo (100mL) normal saline (NS). Group II: The patients were given 2g Mg in 100mL NS. Results: In group II significant decrease in CT (clotting time) in EXTEM (which evaluates the extrinsic pathway after addition of tissue factor), INTEM (which evaluates the intrinsic pathway after contact activation), APTEM (assess fibrinolytic pathway) and FIBTEM (assess fibrinogen level after tissue factor activation), decrease in clot formation time (CFT) in EXTEM, increase α-angel (the angle determined from the reaction time to the inflection point of the amplitude of the forming clot), in INTEM and FIBTEM and increase A10 (clot strength after 10min) EXTEM, FIBTEM and APTEM in comparison with group I. Conclusions: (1) The ROTEM analysis shows the effect of Mg ions in coagulation that can be assessed by laboratories not clinically. (2) Mg improved coagulation in patients about to undergo liver transplantation who showed ROTEM evidence of hypocoagulability. [Copyright &y& Elsevier]