Clinical Characteristics, Etiologies, and Outcomes of Pediatric Liver Graft Failure

Sunday, March 22, 2026

11:00 AM - 12:00 PM Central Time

Location: Connections Central - RST 18

Nour Y. Gebara, MD (she/her/hers)

Baylor College of Medicine Texas Children's Hospital, Texas

Disclosure(s): No relevant financial relationship(s) to disclose.
DB

Dalia A. Bashir, MD

Assistant Professor of Pediatrics
Baylor College of Medicine/ Texas Children's Hospital

Disclosure information not submitted.
DS

Divya Sabapathy, MD, MPH

Assistant Professor
Baylor College of Medicine/ Texas Children's Hospital

Disclosure information not submitted.
AB

Anna Banc-Husu, MD, MSCI

Assistant Professor of Pediatrics
Baylor College of Medicine/ Texas Children's Hospital

Disclosure information not submitted.
EM

Elizabeth A. Moulton, MD

Assistant Professor
Baylor College of Medicine/ Texas Children's Hospital

Disclosure information not submitted.
JC

Jorge Coss-Bu, MD, FCCM

Professor
Baylor College of Medicine/ Texas Children's Hospital, Texas

Disclosure information not submitted.
Fong W. Lam, Non-Member Physician (he/him/his)

Baylor College of Medicine, Texas

Disclosure information not submitted.
TF

Thomas Fogarty, MD, FAAP

Assistant Professor
Baylor College of Medicine/ Texas Children's Hospital, Texas

Disclosure information not submitted.
ST

Sameer Thadani, MD

Baylor College of Medicine Texas Children's Hospital, Texas

Disclosure(s): No relevant financial relationship(s) to disclose.
MG

Meghana Gudala, MBBS, MS

Clinical Data Specialist
Baylor College of Medicine/ Texas Children's Hospital

Disclosure information not submitted.
SK

Sarah Koohmaraie, BSN, RN

Liver Transplant Coordinator
Baylor College of Medicine/ Texas Children's Hospital

Disclosure information not submitted.
MD

Moreshwar S. Desai, MD

Associate Professor
Baylor College of Medicine/ Texas Children's Hospital, Texas

Disclosure information not submitted.

Introduction: Despite advances in pediatric liver transplantation (LT), graft failure (GF) remains a devastating complication with limited data on etiology and outcomes to inform decisions about repeat LT. We hypothesize that patients with GF secondary to vascular thrombosis have better survival compared to those with non-vascular causes.

Methods: We conducted a retrospective review of pediatric liver transplant (LT) recipients who met criteria for graft failure (GF), defined as either being relisted for re-transplantation or dying prior to relisting, at a quaternary pediatric hospital between 2011 and 2024. Patients who received multi-organ transplants, or were transferred to another institution at the time of GF were excluded. GF was classified as either vascular (imaging-confirmed hepatic and/or portal vein thrombosis) or non-vascular (rejection, infection, or primary non-function), and grouped as early (≤30 days post-LT) or late (> 30 days) GF. Our primary outcome was survival to re-transplantation following a first time GF.

Results: Of 600 patients listed for LT, 42 (7%) met the study criteria for GF. Most patients were female (69%), and median age at first transplant was 1 (0–6) years. Race and ethnicity were diverse, with 38% identifying as Hispanic, followed by 28% White, 24% Black/African American, and others. The most common diagnosis was biliary atresia (45%). Median time to GF was 341 (7–1192) days, with 17 (40%) early and 25 (60%) late GFs. Twenty-one (50%) of the GFs were secondary to vascular thrombosis. Vascular GF was more likely to occur early (76% vs. 5%, p< 0.0001), and patients with vascular GF had higher survival to re-transplant following first GF compared to non-vascular GF (62% vs. 29%, p=0.03). Survival was comparable between early and late groups (47% vs. 44%, p=NS). Overall, 27 (64%) patients died, of which 23 (55%) died awaiting a first re-transplantation.

Conclusions: Pediatric GF occurs infrequently but is associated with high mortality. Children with vascular GF have a better chance of survival compared to those with non-vascular causes. While the etiology of GF was associated with survival, timing was not. Future studies exploring additional patient-level factors that may influence GF survival in children are necessary.