Analysis of the indications for primary liver transplantation related to the eras, shows a significant shift of the percentual share of transplant indications in our center from some of the “classic” indications for pediatric liver transplantation, such as PFIC and a1AT-deficiency, to more complicated, often multisystemic indications such as metabolic diseases and malignancy. Here, SERPINA1 is linked to Other metabolic disease.