Aim: Liver transplant (LT) is the standard treatment for pediatric end stage liver disease. One year graft and survival rates after pediatric LT are reported to be near 90%. However, complications often persist and can adversely affect outcomes, so early detection is essential, especially for smaller pediatric patients. Here, we aimed to; evaluate the predisposing risk factors affecting the early LT outcomes in children ≤3 years old, as can be named as the most challenging group of the liver transplant.

Materials and Methods: Since December 1988, we performed 701 liver transplant (LT) procedures (334 pediatric, 367 adult) at our center. Among these 334 pediatric liver transplants, 146 patients were younger than 3 years old (mean 14, 94 months). We retrospectively evaluated the demographic and surgical features of these patients younger than 3 years old and define the predisposing factors affecting the early LT outcomes.

Results: Among these 146 recipients who were ≤3 years, we lost 14 LT patients during the first month of LT. Besides these early mortality 61 LT survived for 2-10 years, 41 LT survived for more than 10 years.  The retrospective analysis of the patients were done according to the demographic data, surgical features and postoperative complications. Our overall patient and graft survival rates and the risk factors were found to be similar with the previous reports. The results showed that predictors of early mortality were found to be; preoperative high PELD score (<30 vs ≥30) (p 0,006), preoperative low body weight (<6 vs ≥6 kg) (p 0,025) and presence of postoperative hepatic artery complication (p 0,024).

Conclusion: Greater caution is needed for pediatric patients with low bodyweight and high PELD scores and further technical innovations and careful management are required to deal with hepatic artery reconstruction to improve survival of LT patient’s ≤3 years old.