Liver transplantation (LT) is the ultimate treatment for portal hypertension (PHT). Pathophysiological changes such as portal vein thrombosis (PVT), cavernous transformation of portal vein (CTPV) and splenic artery steal syndrome (SASS) during PHT exert significant impact on the blood supply of liver allograft, which not only significantly increases the risk of LT, but also probably affects the long-term survival of liver allograft. Preoperatively, surgical indications should be selected reasonably, and it is recommended to prepare multiple regimens for vascular reconstruction. Intraoperative embolectomy and identifying usable veins are key procedures. Controlling wound surface and shortening the operation time play crucial roles in reducing perioperative complications and death. The monitoring of portal vein and hepatic artery perfusion should be performed throughout the whole process before and after LT. In this article, common pathological changes of portal vein and hepatic artery during PHT, underlying mechanism, short-term and long-term effects on intraoperative and postoperative periods of LT and corresponding countermeasures were illustrated and discussed.