The number of  liver transplantation (LT) performed in pediatric patients born prematurely (BP) has been increasing each year. This trend results from improvements in the treatment of preterm infants.
The aim of the study is to assess the outcomes of LT in children born prematurely.
Methods/Materials: Retrospective cohort study. Prematurity was defined as a gestational age (GA) of  ≤ 36 weeks. Between 2015 and 2024, 29 children born prematurely (BP) underwent LT. A control group of full-term (FT) children (n=134) with similar demographic parameters and primary diagnosis was established for the purpose of comparing treatment outcomes.  
We analyzed recipient demographics, neonatal, surgical, transplant-related and pediatric complications, as well as long-term outcomes.
Results : The median GA of BP was 30 (26-35) weeks. The median age at LT was higher in the BP group 17 (9-35) months vs 10 (8-28) months in FT. The median weight was similar between the two groups: 9,2 kg for BP and 8,2 kg for FT. 14 patients born before 32 GA were diagnosed with typical complications of prematurity.
The most common indications for LT in the BP group were biliary atresia and cholestatic cirrhosis of unknown etiology (n=23). The rate of LT from a living donor was similar in both groups (90% in BP group and 86% in FT group). Median follow-up time after LT was 4,2 years for patients in the BP group and 5 years in the FT group.
Patients in the BP group had longer intensive care unit stays (median: 6 vs 4 days) and overall longer hospitalization times (52 vs 38 days). Need for delayed abdominal closure was similar in both groups (79%).
Early vascular thrombosis occurred in one patient in BP group (hepatic artery) and in ten patients in FT group (four in hepatic artery and six in portal vein). In most children successful thrombectomy resulted in revascularization.
Early biliary complications (biliary leak, anastomotic stricture) were slightly more frequent in the FT (27% v 23%). Preterm patients were significantly more likely to require early surgical revision due to intestinal obstruction or perforation (17% vs. 6%).
CMV infection was diagnosed in 20% of patients in both groups. EBV infection was slightly more frequent in the FT group (31 vs 27%), whereas post-transplant lymphoproliferative disease  occurred more often in the BP group (7% vs 4%).
Patients in the BP group experienced  higher incidence of acute rejection episodes during whole follow up period (41% vs 31%).
Three patients required retransplantation: one in the BP group (primary nonfunction) and two in the FT group (acute centrilobular necrosis, severe antibody-related rejection). The 1-year patient survival rate was 93% for the BP group and 96% for the FT group.
Conclusions: Pediatric and surgical complications during the perioperative period are more common in patients born prematurely and often lead to prolonged hospitalization. However, graft and patient survival rates are comparable to those of children born at term.