Background As a result of improved outcomes, referral to pediatric liver transplant (PLT)services has gradually increased but unfortunately graft pool did not show similar expansion resulting in graft shortage. Identifying the pre-transplant predictors of patient and graft survival can help in more effective graft allocation and can be crucial in guiding medical care and re-listing decisions.

Aim Identifying pre-transplant factors that can by itself or in combination predict post-transplant patient and graft survival.

Methods This is a retrospective review of PLT episodes in Leeds Teaching Hospitals NHS trust from 2000 to 2020.Univariate and Multivariate analysis of pre-transplant factors were used to identify predictors of patient and graft survival. We classified aetiology of liver disease into 6 broad categories: End stage chronic liver disease (ESCLD),Acute liver failure (ALF),acute on top of ESCLD, metabolic liver disease, tumours and re-transplantation. Grafts used were divided into whole and technical variant grafts where technical variant grafts include all split and reduced grafts, technical variant grafts were further divided into grafts from cadaveric or living donors (LD).

Results 276 patients in our centre received 320 LTs. ESCLD was the main indication (60.6%) followed by re-transplantation (13.7%), ALF (10.3%), tumours (8.8%), metabolic (5.3%) and acute on top of ESCLD (1.3%). Source of liver grafts were DBD donors in 271 (84.7%) transplant episodes while 49 grafts (15.3%) were from living donors. Number of grafts per patient was one graft in 276 patients (86.2%), two grafts in 39 patients (12.2%) and three grafts in 5 (1.6%) patients. Recipients who required pre-transplant mechanical ventilation were 24 (7.5%)recipients 0.44(13.8%) patients required re-transplantation. Most common cause of graft loss was hepatic artery thrombosis (HAT) in 13 re-transplants (29.6%). At the end of study, 239(86.6%) recipients survived while 37 (13.4%) died. Most common cause of death was sepsis. Univariate analysis for patient survival (table 1) showed that following variables had a significant (p<0.05) impact on overall patient survival: patient age, patient weight, patient height, graft type, category, era of transplant and invasive ventilation. Univariate analysis for graft survival showed that the following variables had a significant (p<0.05) impact on graft survival: patient age, patient weight, patient height, category, and era of transplant. Multivariate statistical analysis of Patient and graft Survival showed that the only significant factor for graft and patient survival is the era of transplant where patients transplanted after 2010 has significantly higher recipient and graft survival.

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Abstract P42 Figure 1

Patient Kaplan-Meier survival curve Figure 2: Graft Kaplan-Meier survival curve

Summary This study, spanning over about 20 years, represents one of the biggest UK based PLT single centre reports. Only significant factor for patient and graft survival was era of transplant with PLT after 2010 has significantly better patient and graft survival.

Conclusion Building experience has substantial effect on patient and graft survival. Traditional view of worse outcomes of smaller candidates should be changed especially in high volume centres with prolonged experience.