Introduction: RCWMCH is one of only 2 centres in South Africa performing paediatric liver transplants. The first paediatric liver transplant (LTx) in South Africa was performed at RCWMCH in 1987 and up until 2022 a total of 141 LTx have been performed in our centre.  A successful paediatric LTx program requires a multidisciplinary team. It is important to review the results of these LTx patients both in terms of their complications and outcomes in order to assess the success of this program.
Method: Review of the RCWMCH paediatric LTx database between 2003 and 2022 and highlights the demographics, complications and survival rates.
Results: Seventy one of the total 141 paediatric LTx were performed during this study period. 8 of 11 total combined liver kidney transplants were performed in study period.
There were 25 males and 46 females with a median age 32 months (2yrs 8mnths). 50/71 (70%) were transplanted for extrahepatic biliary atresia. All transplants during this period were deceased donors and the most common graft type was the Left Lateral Segment of the liver (25/71; 35%).
The 1 and 5 year survival rates were 82.6% and 72.5% respectively. A total of 6/71 (8.4%) patients died within 1 month post-transplant of which 3 were due to Hepatic Artery thrombosis (HAT). Other post-transplant complications included post-transplant lymphoproliferative disease (12), HAT (5), portal vein thrombosis (7) and bile duct pathology (16). 
In terms of facilitating the program there was a requirement not only for appropriately trained paediatric transplant coordinators, paediatric surgeons, hepatologists and interventional radiologists but also paediatric anaesthetists and intensivists with a robust paediatric intensive care unit supported by well-trained nursing staff, physiotherapists, dietitians, social workers, laboratory services, blood bank and hospital managers.
Conclusion: Paediatric LTx requires a multidisciplinary team of health care workers dedicated to transplantation and with careful planning is possible in a less well-resourced region. This study demonstrates that a paediatric liver transplant program is possible in a South African dedicated children’s state hospital and highlights challenges that must be addressed to further improve outcomes in paediatric liver transplantation.