Among a total number of 7,474 liver transplants, 2,639 pediatric liver transplants were performed until the end of 2013. The Japanese Liver Transplant Registry revealed excellent outcomes of pediatric liver transplantations, 91.8% at 5-year patient survival rate, as a result of recent advances not only in surgical procedures, but also in perioperative management. The indication of pediatric liver transplantation has been widely expanded; especially small children suffering from critical liver disease in infancy can now undergo living donor liver transplantation (LDLT) by using monosegmental grafts. Although the number of deceased donor liver transplantation is still low in Japan, split liver transplantation is a promising way to expand the donor pool. Domino liver transplantation, using the liver from maple syrup urine disease, has also recently been launched as another therapeutic option of LDLT.