Liver transplantation is the only effective treatment for end stage liver disease. In recent years the results of this major procedure have improved progressively in adults and children.1-4 At Addenbrooke’s Hospital, Cambridge, the children’s liver transplantation programme was started in January 1984. By December 1996, 200 children had received 284 liver grafts. In December 1998, 138 (69%) of these children were alive more than two years after their first liver graft, 120 were alive after more than five years, and 37 were alive after more than 10 years. In the past 10 years the one year survival rate has increased to 87%. After a successful transplant, children can return to full health and activity, with normal growth and development, but have to continue lifelong immunosuppression.

Liver transplantation remains a difficult and dangerous operation. Most of the acute and life threatening problems occur in the first postoperative days and weeks, and therefore during the initial admission, but important later complications develop in as many as one third of children.3 4 As the number of children surviving transplantation has increased, many general paediatricians and general practitioners have become involved in sharing the care of these children with transplant units. It is therefore important that the local medical team is conversant with the potential late complications of transplantation.

In this paper we review our own and the reported experience of late complications in children after liver transplantation. Guidelines on preliminary investigation and management are summarised in table 1, and fig 1 illustrates possible sites of biliary and vascular strictures and occlusions.