Pediatric liver transplantation is an important medical treatment that can save the life of a child with end-stage liver disease. Organ transplants began in the 1950s and took a new turn in 1963 with the first pediatric liver transplant in Denver, USA. However, the initial success rate was unsatisfactory due to technical difficulties and lack of immunosuppressive treatment. Later, introduction of immunosuppressants such as cyclosporine and tacrolimus improved the success rate, and pediatric liver transplants became widely available. This manuscript describes the history, current situation, issues, and future prospects for pediatric liver transplantation in Japan.