Outcome analysis from the United Network for Organ Sharing (UNOS) Scientific registry was performed on 3,409 pediatric liver transplants from data accrued between 1990 to 1996. Liver grafts consisted of 2,636 whole grafts (WLG), 246 live-donor grafts (LDG), 89 split-liver grafts (SLG), and 438 reduced-size grafts (RSG). One-year graft and patient survival rates for 3,409 transplants were 69.7% and 81.9%, respectively, and were significantly higher (P<.001) in nonhospitalized patients (79.8% and 91.3% vs. 61.0% and 73.7%). LDG graft survival (75.9%) was comparable with WLG (70.9%) but significantly better at 1 year than SLG (60.3%, P=.007) and RSG (61.1%, P=.001), even after excluding retransplants and ICU patients. A separate analysis of outcomes in recipients less than 1 year of age suggested significantly better graft and patient survivals for LDG (83.3% and 89.4%) than for WLG (62.3% and 76.5%) and SLG(62.7% and 75%). Live-donor grafts demonstrate consistently superior graft and patient outcomes in pediatric recipients less than 1 year of age, and should be promoted aggressively as a solution to the critical shortage of size-matched grafts in small recipients.