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Portal venous pressure (PVP) measurement is essential for the management of cirrhosis-related portal hypertension. Unlike indirect assessments using hepatic venous pressure gradient (HVPG) measurements, the new endoscopic ultrasound (EUS)-guided technique offers direct PVP measurement. In this observational study, direct PVP measurement by EUS demonstrated good correlation with intraoperative PVP readings in patients with decompensated cirrhosis undergoing living donor liver transplantation (LDLT). The novel compact manometer (CM) and conventional central venous pressure (CVP) measurement system connected via the pressure transducer showed reasonable correlation for EUS PVP preoperatively (Pearson coefficient 0.72) and good correlation intraoperatively (Pearson coefficient 0.96). Only minimal adverse events were observed.