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 Starzl on a three-year-old child with
biliary atresia.1 The infant did not survive the operation and it
was not until four 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 one-year mortality remained high at
around 50% and it was not until cyclosporine was introduced
in 1980 that survivals dramatically increased. Eleven of the first
12 recipients receiving cyclosporine and prednisone immune
suppression therapy lived more than one year and seven
survived at least 12 years.2,3 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
similar but more powerful drug, pushed the boundaries of
success even further.4 Further technical advances included
reduced size liver transplantation,5 split liver transplants,6 and
living related transplants.7,8
