Evolution of pediatric liver transplant: from inception to modern practice

This article explores the historical development of pediatric liver transplantation (LT), tracing its evolution from the first experimental procedures to modern high‑tech approaches. Throughout its history, LT in children has been a catalyst for innovation and novel surgical techniques. The earliest attempts at pediatric LT faced numerous technical and immunological challenges and were associated with extremely high mortality rates. A major breakthrough occurred in the 1980s with the introduction of cyclosporine A. During this period, pioneering advances such as reduced-size grafts, split-liver transplantation, and the first successful living-related donor procedures marked a new era. The 1990s witnessed further progress in surgical techniques, introduction of tacrolimus, and the development of right-lobe living donor transplantation. These innovations not only expanded the donor pool significantly but also improved surgical outcomes. Entering the 21st century, the field experienced further breakthroughs with the implementation of ABO-incompatible transplantation and the adoption of MELD and PELD scoring systems for organ allocation. In addition, the integration of minimally invasive laparoscopic and robot-assisted approaches reduced donor morbidity and improved postoperative recovery. Today, pediatric LT is recognized not only as a life-saving treatment for end-stage liver failure in children but also as a driving force of innovation in modern transplant practice. The article underscores the importance of continuous refinement of surgical techniques and personalization of immunosuppressive regimens as key strategies to improve long-term survival and enhance the quality of life in pediatric LT recipients.