ABSTRACT
One of the prime stimuli for the development of liver transplantation was the inevitable mortality from infant liver disease, and many of the advances in liver transplantation techniques were prompted by the need to tailor the procedure for the pediatric patient. The first ever human transplant was attempted in 1963 by Starzl1 on a 3-year-old child with biliary atresia. The infant did not survive the operation, and it was not until 4 years later that he obtained “success” in achieving survival for 400 days in an 18-month-old girl with a malignant liver tumor. She died from disseminated metastases. Over the next decade, 1-year mortality remained high at around 50%, and it was not until cyclosporine was introduced in 1980 that survivals dramatically increased. In June 1983 at the National Institutes of Health Consensus Development Conference, liver transplantation was declared a valid treatment for end-stage liver disease. The introduction a decade later of tacrolimus, a more potent calcineurin inhibitor, pushed the boundaries of success even further. Technical advances included reduced-size liver transplantation,2 split-liver, transplants,3 and living related transplants.4
