The children's liver transplantation program at the University of Louvain Medical School in Brussels has been organized with a multidisciplinary pediatric approach. The age distribution of the first 139 patients transplanted between March 1984 and June 1989 is characterized by the distinct preponderance of infants and small children (62.5% younger than 3 years, 16 younger than 1 year). Biliary atresia unalleviated by the Kasai portoenterostomy or its modifications was the single most frequent indication (101 cases) followed by the heterogenous group of metabolic diseases (17 cases). Two children underwent combined liver and kidney transplantation. A prominent feature of this series is the routine use of the reduced-size liver (40% of the 171 grafts) to alleviate the shortage of size-matched pediatric donors. The actuarial survival rate of the 139 children was 75.8% at 1 year and 72.4% at 2 years and thereafter. For patients who received 1 graft electively, the 1-year survival rates were 85.2% and 92.5% for those who received a full-size or a reduced-size liver with the same proportion (83%) of long-term surviving patients having normal liver tests. Long-term survival rates were not influenced by age, except for infants younger than 1 year with 62.4% surviving at 1-year posttransplantation. This latter group included a vast majority (14 of 16) of severely debilitated biliary atresia cases in preterminal condition. Graft loss from rejection was kept at a low rate of 5.2% (acute in 5-2.9% and chronic in 4-2.3%).