The results of 68 cadaveric (Cad) and 48 living-related (LR) pediatric liver transplants performed between July 1993 and March 1997 were analyzed. Pretransplant mortality, post-transplant survival, and surgical and immunologic complications were retrospectively compared in both groups. The pretransplant mortality rate was 10 (15%) of 68 versus 1 (2%) of 42 in the Cad and LR groups, respectively (P=.049). Post-transplant 1-year patient and graft survival rates were 87% and 75% in the Cad group (n=49) versus 92% and 90% in the LR group (n=41), respectively (NS). The incidence of post-transplant complications was as follows: hepatic artery thrombosis (Cad - 16%, LR - 0%, P=.02), portal vein thrombosis (Cad - 8%, LR - 2%, NS), and biliary complications (Cad - 14%, LR 34 %, P=.044). The overall incidence of acute rejection was similar in both groups; however, a lower incidence of acute rejection occurred in LR graft recipients treated with tacrolimus. The introduction of a LR donor liver transplantation program allowed a significant decrease in the pretransplant mortality rate, with a consequent overall improvement in patient survival compared with the cadaveric series.