Liver transplantation is a treatment, used in children with end-stage liver disease. The ultimate goal of pediatric liver transplantation should be to achieve complete donor safety and zero recipient mortality. Fortunately, the outcomes of liver transplantation have been improved through advances in immunosuppression, surgical procedures, and the allocation system for liver donors. However, a salient fact that governs all in pediatric liver transplantation is that there are still post-operative mortalities despite our best attempts. Mortalities occur due to various causes; not only surgical issues but also post-operative medical issues. Herein, pediatric hepatologists must know perioperative issues in detail to optimize posttransplant survival. They include pretransplant conditions (candidate evaluation, waiting period, and nutrition), surgery (esp. immediate surgical complications), and early- and late- posttransplant courses (infection, immunosuppression). Guidelines from developed countries and experienced centers are truly important, but not enough to answer all real-world situations. Therefore, practitioner should gain his own deep insight into pediatric transplantation. I believe, based on generalized care guidelines and center-oriented experiences, comprehensive advances in meticulous management may eventually realize a zero-mortality rate in pediatric liver transplantation.
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