Outcomes of left lateral segment (LLS) grafts in pediatric recipients were compared between living (LD-LLS) and deceased donor (DD-LLS) grafts. 195 LLS grafts (99DD-LLS-96LD-LLS) were analyzed with a median follow-up of 9.1years. The primary endpoints were overall patient/graft survival. LD-LLS grafts were younger (0.9vs.1.4years, p=0.039), more likely to have a fulminant liver failure (17.9%vs.5.3%,p=0.002), less likely to have a metabolic disorder (6.3%vs.25.5%,p=0.002), and less likely to be undergoing retransplantation (5.3% vs.16.2%,p=0.015). There was a trend toward decreased hepatic artery thrombosis in LD-LLS grafts (6.6% vs. 15.5%,p=0.054). No differences in the overall biliary complications occurred. The LD-LLS group had prolonged survival compared to the DD-LLS group with 10-year survival rates of 81%, and 74% (p=0.005), respectively. LD-LLS grafts had longer graft survival compared to DD-LLS grafts (10-year graft survival 85%vs.67%,p=0.005). Recipient age >1year (HR 2.39,p=0.026), aortic reconstruction (HR 2.12,p=0.046) and vascular complication (HR 3.12,p<0.001) were independent predictors of poor patient survival. Non-biliary liver disease (HR 2.17,p=0.015), DD-LLS (HR 2.06,p=0.034) and vascular complication (HR 4.61,p<0.001) were independent predictors of poor graft survival. The use of SLT remains a viable option with excellent long-term outcomes. We show improved graft and patient survival with living donor grafts.

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