Abstract With increasing experience and improving results, liver transplantation is now a standard treatment for a wide range of liver diseases in children. It is now clear that patients will benefit mostly from early elective transplant before the development of severe liver dysfunction, malnutrition, significant growth and psycho-motor retardation, or other disease-related morbidity. Therefore, attention must be given to early referral to transplant centres, and also to preserve adequate clinical condition while waiting. Innovative surgical techniques such as liver reduction or splitting still play a major role in facing the ever-increasing problem of relative donor shortage. Long-term survival rates after elective transplants are 85–90%, and most children enjoy a good quality of life, close to normal, with a high chance of normal growth, motor development and school attendance. However, increasing attention must be given to prevent possible late chronic disabilities, especially renal dysfunction.