Liver Retransplantation in Pediatric Recipients: A 20-Year Single-Center Experience With 25 Cases

Pediatric liver retransplantation (ReLT) remains technically complex and is associated with increased postoperative complications and mortality. However, pediatric-specific data including surgical challenges are limited. This retrospective single-center study evaluated long-term outcomes, complications, and surgical considerations of pediatric ReLT.

In this retrospective single-center study, we analyzed 25 pediatric patients (< 18 years) who underwent ReLT between 2005 and 2025. Clinical characteristics, perioperative variables, postoperative complications, and survival outcomes were assessed. Patient and graft survival were estimated using Kaplan-Meier analysis, and prognostic factors for mortality were examined using univariate logistic regression.

Among 908 primary liver transplant recipients, 25 patients (2.7%) underwent ReLT. The mean age at ReLT was 5.5 years, with a mean interval of 3.0 years from primary transplantation. Major indications included refractory rejection (n = 14, 56.0%) and chronic rejection (n = 7, 28.0%), and early ReLT (< 1 year) was performed in 17 patients (68.0%). Patient survival at 1, 3, and 5 years was 83.6%, 79.5%, and 79.5%, respectively, with corresponding graft survival of 78.7%. Kaplan-Meier analysis showed no statistically significant difference in patient or graft survival according to donor type or timing of ReLT. Although complex vascular reconstruction was frequently required, no early vascular complications occurred. Early postoperative complications developed in 13 patients (52.0%). Graft failure was the only factor significantly associated with mortality.

In conclusion, liver retransplantation in pediatric recipients remains a complex but feasible treatment option with acceptable outcomes. However, given the small sample size and single-center nature of this study, further multicenter investigations are required to better define prognostic factors and optimize management strategies.