Liver transplantation has become an effective treatment for end-stage liver disease in both adults and children. A review of the history of liver transplantation reveals that many of the major advances in liver transplantation have been related to children. For example, in 1963, Professor Starzl performed the first human liver transplant in a 3-year-old child with congenital biliary atresia; in 1966, the first child with liver cancer survived for more than a year, also at the age of 1.5 years; and in 1970, Professor Starzl performed a pediatric liver transplant that holds the record for the longest survival time (39 years), and the child is now an adult at the Starzl Transplant Institute. He is now working at the Thomas E. Starzl Transplantation Institute. Other new techniques such as split liver transplantation and living liver transplantation were initially developed to alleviate the shortage of livers in children. But in fact it was not until the 1970s that liver transplantation in children was routinely used in the clinic. Advances in immunosuppression (Calne et al. 1979), improvements in organ preservation methods (Collins et al. 1969, Belzer and Southard 1988), and progressive research into the pathophysiology of liver transplantation have transformed liver transplantation from a restricted, high-risk area to the standard, predictable treatment modality it is today. Advances in these areas have also brought great benefits to the development of liver transplantation in children. Other advances such as post-transplantation intensive care, anti-infective treatment, and prevention and treatment of recurrence of primary disease have also benefited pediatric liver transplantation. This has led to the expansion of surgical indications to critically ill children and infants with acute liver failure. By the 1980s, the 6-month survival rate for children had increased from 35% to 40% to 70% to 80%. In some transplant centers, the survival rate is even as high as 90%, and even with repeat liver transplantation, the 1-year post-operative survival rate is 50%, making liver transplantation a routine treatment for end-stage liver disease in children. To date, more than 10,000 children have received liver transplants worldwide. For example, when people encounter a child with biliary atresia, the first thing they think of is liver transplantation to save the child’s life, instead of considering liver transplantation only after the Kasai procedure if the results are not satisfactory. Moreover, many pediatric hepatologists have changed their attitude toward liver transplantation. In the past, children with liver disease, even at the end stage, were delayed as much as possible until the last resort, but now the attitude is more positive. For a long time, the main obstacle to the development of liver transplantation in children was the lack of suitable donors. Prior to the advent of new technologies, volume-matched whole liver transplantation was the standard procedure, resulting in a 35% mortality rate in children awaiting liver transplantation. The incidence of various end-stage liver diseases has varied over time, resulting in a disproportionate number between infants and older children. To alleviate the volume matching problem between donors and recipients, volume reduction liver transplantation techniques were applied to the clinic, but resulted in a relative decrease in the number of adult liver transplants. In contrast, split-liver transplantation and living liver transplantation effectively alleviate the relative lack of donors and have become the most commonly used procedures for liver transplantation in children. The current 1-year survival rate of pediatric patients with chronic liver disease undergoing liver transplantation is 80-90%, and most children have the same quality of life as their peers after surgery.