In the lOt years between the spring of 1963 and the fall of 1974, liver transplantation was attempted in 93 patients by removing the diseased native liver ;. and r~placing it with a cadaveric homograft in the natural (orthotopic) location. Fifty-six of the liver recipients were 18 years old or younger; the other 37 were adults.The following report will be concerned with the 56 pediatric patients, of whom 40 carried the diagnosis of biliary atresia. Attention will be directed to the need in the treatment of biliary atresia to develop a unified philosophy in which the porticoenterostomy of Kasai and liver transplantation are perceived to be complementary rather than competitive components of the continuum of care. CASE MATERIALThe indication for operation was something other than biliary atresia in only ! 6 of the 56 pediatric recipients. The mean age of these 16 patients at the time of transplantation was 12.9±4.6 (S.D.) years '(range I to 18 years). Nine of the 16 patients had some variant of chronic aggressive hepatitis without HBsAg antigenemia (table 1). Three more had hepatomas for which conventional partial hepatectomy was not feasible. Two had Wilson's disease. There was one example each of congenital biliary cirrhosis and cirrhosis associated with homozygous alpha-I-antitrypsin deficihcy of the PiZZ phenotype.The 40 patients who had biliary atresia were 42.0±37.7 (S.D.) months old (range 3 to 191 months) at the time of transplantation. The four oldest

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