Because transplantation remains the only treatment of end-stage liver disease, an increase in the number of transplant centers and efforts to expand the donor pool have not been able to keep up with need. Statistics regarding outcome of the pediatric patients on the UNOS transplant list are difficult to interpret owing to the widespread non-adherence to the pediatric end-stage liver disease (PELD) scoring system.2 The lack of suitable-sized organs has led to utilizing higher risk and more complex alternatives. However, it is clear that children under 1 year of age on the transplant waiting list have the greatest risk of death