Survival Determinants in Pediatric Liver Transplant From a Single Center Performing Primarily Living Donor Transplants

Objectives: Despite advances in surgical technique and postoperative care, pediatric liver transplant outcomes remain highly variable, particularly in centers with limited access to deceased donor organs. We evaluated survival rates and identified key clinical, surgical, and laboratory parameters associated with posttransplant mortality in a high-volume single center performing primarily living donor liver transplants. Materials and Methods: We retrospectively analyzed 98 pediatric liver transplants performed from January 2018 to February 2024 at the Istinye University Organ Transplantation Unit, Istanbul, Türkiye. All cases were ABO compatible. Assessed variables included recipient demographic data, indications, weight, preoperative and postoperative day 7 laboratory results, graft type, and complications. Survival was defined as time from liver transplant to death from any cause. Kaplan-Meier and Cox regression analyses were used to identify predictors of survival. P < .05 was considered statistically significant. Results: Median age at transplant was 17 months; 51.0% of patients weighed ≤10 kg. Living donor transplants accounted for 92.6% of cases. Overall crude survival was 74.5%. Cumulative survival rates at 6 months, 1 year, and 3 years were 78.5%, 77.4%, and 73.2%, respectively. Kaplan-Meier survival analysis showed that recipients with a body weight of ≤10 kg had a significantly higher mortality rate and shorter overall survival (P = .012). Multivariate Cox regression identified 2 independent predictors of mortality: higher graft-to-recipient weight ratio (hazard ratio 1.498; P = .032) and platelet count decrease for each increment of 10 000 platelets/mm³ on postoperative day 7 (hazard ratio 1.046; P = .004). Conclusions: This study highlights 3 modifiable or monitorable factors, that is, low transplant weight, high graft-to-recipient weight ratio, and early postoperative thrombocytopenia, as key predictors of reduced survival in pediatric liver transplant recipients. These findings emphasize the need for careful donor-recipient matching and early postoperative monitoring, particularly in centers that rely primarily on living donor transplants.