Abstract
The pioneers of liver transplantation established thetechnical aspects of orthotopic grafting and its efficacyas a treatment for endstage liver disease. Progress washampered by rejection, but the improved immuno-therapy provided by cyclosporine was followed by ex-ponential growth in clinical liver transplantation duringthe 1980s, with expansion in the number of transplantcenters around the world and the consequent rapidincrease in the number of transplants performed. Thesuccess of the procedure, the reduction in the absoluteand relative contraindications to liver transplantation,and the widening of the spectrum of disease processesdeemed amenable to liver replacement led to the num-ber of patients waiting for a liver transplant far exceed-ing the available donor liver grafts. Due to the paucityof whole organs from pediatric donors, this discrepancywas always present for young children, for whom therewas a pretransplant mortality of greater than 25%.
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