Background: Pediatric liver transplantation (LT) has evolved into a highly successful therapeutic modality for end-stage liver disease. This study aims to analyze and highlight the outcomes of pediatric LT from a single tertiary care center.
Methods: A retrospective analysis of 78 pediatric liver transplants performed over 5 years was conducted. Baseline demographics, perioperative details, and post-transplant outcomes were assessed with a focus on survival, graft function and complications.
Results: The median age at transplant was 6 years, with a median PELD score of 23 (IQR:14,34). Living donor liver transplantation (LDLT) accounted for the majority (81%) of procedures. The most common etiology for liver transplantation was Wilson disease (24.4%), closely followed by Biliary atresia (20.5%). The median time interval from diagnosis to liver transplant was 219 (60, 1035) days. Infants (age <1year) had a higher risk of developing sepsis in the immediate post transplant period and peak aspartate aminotransferase, alanine aminotransferase and international normalised ratio were higher in children who had sepsis (p=0.001,p=0.013,p=0.029 respectively). Importantly, the type of liver failure (acute or chronic) and occurrence of post-operative sepsis did not significantly impact survival outcomes (p > 0.05). Median time to normalization of liver function tests was 13 days, reflecting excellent graft function. The median follow-up duration was 26 months. Acute rejection was seen in only 12.8% of recipients, with 90% responding to steroids alone. The overall 5-year patient survival rate was an encouraging 70.5%, with a low re-transplantation rate of 2.5%.

Conclusion: This study demonstrates that pediatric liver transplantation, is associated with excellent long-term survival and graft outcomes. Effective perioperative care, prompt management of complications, and a multidisciplinary approach contribute significantly to these favourable results.