UPDATE: On 7 April 2020, the High Court overturned Cardinal George Pell's conviction for historic child sex offences and acquitted him of the charges. The High Court unanimously found Victoria's Court of Appeal should not have upheld Pell's conviction and that the evidence could not support a guilty verdict.

Disgraced cardinal George Pell left the Victorian County Court yesterday handcuffed and in the back of a prison van, the collar of his shirt bare for the first time since 1966.

The former Vatican treasurer was on his way to the Melbourne Assessment Centre, where he awoke this morning after spending the first night of his three year and eight month sentence.

He is still waiting to learn where he will see out his jail term, but his failing health means he may die in incarceration.

Vision of a cuffed George Pell captured on the security screen in the prison van that took him from court yesterday. (Jason South / The Age)

County Court Chief Judge Peter Kidd handed down his sentence of six years yesterday meaning the Pell will be 80 when his minimum non-parole period expires, with any chance of freedom pinned to his appeal application, to be heard in Victoria's Court of Appeal in June.

A bail application was foreshadowed when his conviction for sexually abusing two choirboys at St Patrick's Cathedral in East Melbourne in 1996 became public.

Pell sat emotionless and looking visibly thinner through more than an hour-long sentence hearing where the judge noted he would spend a "substantial portion" of his remaining life expectancy behind bars.

"I am conscious that a term of imprisonment ... carries with it a real, as distinct from theoretical, possibility that you may not live to be released from prison," Judge Kidd said.

"Your obvious status as Archbishop cast a powerful shadow over this offending.

"In my view, your conduct was permeated by staggering arrogance."

COURTROOM TEARS

After the sentence was handed down, Pell grabbed the railing and lowered himself into the dock.

Chief Judge Peter Kidd's sentencing remarks were broadcast live. (Supplied)

He was surrounded by supporters and his legal team as he signed documents making him a registered sex offender for life.

Pell was found guilty in December of orally raping a 13-year-old choirboy and molesting another at St Patrick's Cathedral after a 1996 Sunday mass.

There were tears from members of the public in the courtroom as Pell was led away to a waiting prison van.

One of the boys died of a heroin overdose in 2014, while the surviving victim is now in his 30s.

'THAT WOULD'VE BEEN HELL FOR HIM'

The father of the deceased victim praised the boy's friend for coming forward.

"He's always been an upstanding fellow," the man, who did not wish to be identified, said in a statement.

Pell appeared frail in the dock during sentencing today. (AAP)

"I'm not surprised that he came forward. I'm not surprised that he did what he did.

"He kept it in for a long time and that would've been hell for him. Absolute hell.

"But I'm really appreciative and thankful that he did come forward."

Pell is classified as an at-risk prisoner, in need of constant protection.

Outside court, Pell’s barrister Robert Richter QC was asked by reporters how his client will cope behind bars.

A man listens to the Pell sentencing outside court. (AAP)

“Like the man he is,” Richter replied.

The boy's father is unhappy at the length of the sentence.

"Our client is disappointed with the short sentencing and has expressed sadness over what he believes is inadequate for the crime," Lisa Flynn from Shine Lawyers, acting for the family, said.

"I want to be able to tell clients that perpetrators can and will be held to account for the crimes they commit, Pell's criminal conviction is one step towards that.

"Today is the start or a part of a long journey for many victims of abuse around the country.

"For many, the battle against the Catholic church has just begun."

The sacristy of St Patrick's Cathedral, where the sexual abuse occurred. (Victoria Police)

The surviving victim of Pell's abuse gave a statement through his lawyer, Dr Vivian Waller, outside court and said the sentence was overshadowed by the cardinal's impending appeal.

"It is hard for me to allow myself to feel the gravity of this moment: the moment when the sentence is handed down, the moment when justice is done," Dr Waller read.

"It is hard for me, for the time being, to take comfort in this outcome.

"I appreciate that the court has acknowledged what was inflicted upon me as a child.

"However, there is no rest for me."

Pell is the highest-ranking Catholic to be convicted of child sexual abuse. (Getty)

Judge Kidd was scathing of Pell's offending as he explicitly laid out the facts of the case.

"In my view, the first episode in the priest's sacristy involved a brazen and forceful sexual attack on the two victims," Judge Kidd said.

"The acts were sexually graphic. Both victims were visibly and audibly distressed during this offending.

"There is an added layer of degradation and humiliation that each of your victims must have felt in knowing that their abuse had been witnessed by the other."

Pell was led away from court in this prison van. (9news)

Other victims of child sexual abuse and their supporters gathered outside the Melbourne court from dawn.

"When you think that a child's life is destroyed from the moment the abuse occurs to the day that they die, George Pell got off really, really lightly," Rhonda Janetzki from the Care Leavers of Australasia Network told 9News.

"I would have liked to have seen him spend the rest of his natural life in jail reflecting on the crimes he has committed."

Protesters outside the County Court during the sentencing. (AAP)

In his sentencing, Judge Kidd said Pell was not to be held responsible for other abuses within the church.

"You are not to be made a scapegoat for any failings or perceived failings of the Catholic Church," Judge Kidd said.

"Nor are you being sentenced for any failure to prevent or report child sexual abuse by other clergy in the Catholic Church."

Before the sentence was delivered, Prime Minister Scott Morrison urged Australians to support victims of child sexual abuse.

"I would just ask Australians today to get around those who have been victims of child sexual abuse," Mr Morrison said in Melbourne.

"Let them know we know it happened, that we want to help you be stronger and to survive what is the most abominable you could think that could happen to an individual with a breach of trust.

"For me, it's about those against who this abuse was directed and acted upon. It's the most abhorrent thing I can think of."

Pell was until late-February the Vatican's treasurer and is the highest-ranking Catholic to be convicted of child sexual abuse.

Pell maintains his innocence and intends to challenge the conviction in the Court of Appeal, which will be heard in June.