Pediatric Living Donor Liver Transplantation Research Articles

Dextroplantation of a reduced left lateral section graft in an infant undergoing living donor liver transplantation

Graft size matching is essential for successful liver transplantation in infant recipients. We present our technique of graft dextroplantation used in an infant who underwent living donor liver transplantation (LDLT) using a reduced left lateral section (LLS) graft. The patient was an 11-month-old 7.8 kg-weighing female infant with hepatoblastoma. She was partially responsive to systemic chemotherapy, thus LDLT was performed to treat the tumor. The living donor was a 34-year-old mother of the patient. After non-anatomical size reduction, the weight of the reduced LLS graft was 235 g, which was 3.0% of the graft-recipient weight ratio. Recipient hepatectomy was performed according to the standard procedures of pediatric LDLT. At the beginning of graft implantation, the graft was temporarily placed at the abdomen to determine the implantation location. The graft portal vein was anastomosed with an interposed external iliac vein homograft. As the liver graft was not too large and it was partially accommodated in the right subphrenic fossa, the abdominal wall wound was primarily closed. The patient recovered uneventfully. An imaging study revealed deep accommodation of the graft within the right subphrenic fossa. The patient has been doing well for 3 months without any vascular complications. Dextroplantation of a reduced LLS graft can be a useful technical option for LDLT in infant patients.

Pediatric living-donor liver transplantation using right posterior segment grafts

BackgroundThe right posterior segment (RPS) graft was introduced to overcome graft size discrepancy in living donor liver transplantation (LDLT). However, it was very rarely used in pediatric patients. Here we presented 4 pediatric LDLT cases receiving RPS graft between January 2015 and April 2020 in our center. A total of 1868 LDLT procedures were performed in this period.MethodsRecipients included 1 boy and 3 girls with a median age of 45 months (range from 40 to 93 months). They were diagnosed with progressive familial intrahepatic cholestasis, propionic academia, ornithine transcarbamylase and biliary atresia, respectively. Four donors were all mothers with a median age of 32.5 years (31–38 years). Computer tomography angiography indicated posterior right branches branched off separately from main portal veins (type III variation). Three of these donor livers had 1 orifice of right hepatic veins (RHV). In the remaining 1 donor liver, the RHV showed 3 orifices and an outflow patch plastic was performed. Inferior right hepatic veins weren’t found in four donor grafts. The median graft weight was 397.5 g (352–461 g) and the median graft-to-recipient weight ratio was 2.38% (1.44–2.80%).ResultsPostoperative complications occurred in neither donors nor recipients. Within the median follow-up duration of 29 months (14–64 months), four children are all alive with normal liver function.ConclusionIn summary, for older children weighed more than 15 kg with donors’ variation of type III portal veins, the use of RPS grafts could be a feasible and favorable option.

3D-reconstruction and heterotopic implantation of reduced size monosegment or left lateral segment grafts in small infants: A new technique in pediatric living donor liver transplantation to overcome large-for-size syndrome

BackgroundMonosegmental grafts and reduced left lateral segment grafts have been introduced to overcome the problems of large-for-size grafts in pediatric living donor liver transplantation. Here, we introduce a new method of reduced size monosegment or left lateral segment grafts transplanted in the right diaphragmatic fossa heterotopically in small infants. MethodsThere were 4 infants who underwent living donor liver transplantation with heterotopically implanted reduced monosegmental or left lateral segment grafts at our center. The demographic, operative, postoperative, and follow-up data of these infants were collected from our prospectively designed database and reviewed. Technical details of the donor and recipient operation are shared and a supplemental provided. ResultsThe mean recipient age was 7.5 ± 0.9 months (range: 5–10 months), and body weight was 5.9 ± 0.7 kg (range: 4.6–7.8). Primary diagnoses of the recipients were biliary atresia (n:3) and progressive familial intrahepatic cholestasis (n:1). Mean graft-recipient weight ratio was 3.3 ± 0.2. Reduced monosegment III grafts were used in 2 cases, and reduced left lateral segment grafts were used in the other 2 patients. Bile duct reconstruction was done by Roux-en-Y hepaticojejunostomy in 3 patients and duct-to-duct anastomosis in the remaining patient. All patients recovered from the liver transplantation operation and are doing well at a mean follow-up of 8 months. ConclusionLiving donor liver transplantation with heterotopically implanted reduced monosegmental or left lateral segment seems feasible for the treatment of neonates and extremely small infants. Further accumulation of cases and long-term follow-up are necessary to collect data for the establishment of this treatment modality.

Perioperative blood transfusion decreases long-term survival in pediatric living donor liver transplantation

BACKGROUNDThe impact of perioperative blood transfusion on short- and long-term outcomes in pediatric living donor liver transplantation (PLDLT) must still be ascertained, mainly among young children. Clinical and surgical postoperative complications related to perioperative blood transfusion are well described up to three months after adult liver transplantation.AIMTo determine whether transfusion is associated with early and late postoperative complications and mortality in small patients undergoing PLDLT.METHODSWe evaluated the effects of perioperative transfusion on postoperative complications in recipients up to 20 kg of body weight, submitted to PLDLT. A total of 240 patients were retrospectively allocated into two groups according to postoperative complications: Minor complications (n = 109) and major complications (n = 131). Multiple logistic regression analysis identified the volume of perioperative packed red blood cells (RBC) transfusion as the only independent risk factor for major postoperative complications. The receiver operating characteristic curve was drawn to identify the optimal volume of the perioperative RBC transfusion related to the presence of major postoperative complications, defining a cutoff point of 27.5 mL/kg. Subsequently, patients were reallocated to a low-volume transfusion group (LTr; n = 103, RBC ≤ 27.5 mL/kg) and a high-volume transfusion group (HTr; n = 137, RBC > 27.5 mL/kg) so that the outcome could be analyzed.RESULTSHigh-volume transfusion was associated with an increased number of major complications and mortality during hospitalization up to a 10-year follow-up period. During a short-term period, the HTr showed an increase in major infectious, cardiovascular, respiratory, and bleeding complications, with a decrease in rejection complications compared to the LTr. Over a long-term period, the HTr showed an increase in major infectious, cardiovascular, respiratory, and minor neoplastic complications, with a decrease in rejection complications. Additionally, Cox hazard regression found that high-volume RBC transfusion increased the mortality risk by 3.031-fold compared to low-volume transfusion. The Kaplan-Meier survival curves of the studied groups were compared using log-rank tests and the analysis showed significantly decreased graft survival, but with no impact in patient survival related to major complications. On the other hand, there was a significant decrease in both graft and patient survival, with high-volume RBC transfusion.CONCLUSIONTransfusion of RBC volume higher than 27.5 mL/kg during the perioperative period is associated with a significant increase in short- and long-term postoperative morbidity and mortality after PLDLT.

P0096 / #565: THE TRAVAILS OF SETTING UP A LIVING DONOR LIVER TRANSPLANT PROGRAM: THE PICU PERSPECTIVES EXPERIENCE FROM TUNISIA

Aims & Objectives: To report our first experience of PICU care of living donor liver transplant (LDLT) in Tunisia, and the challenges encountered. Methods: This was a retrospective, descriptive study, collecting the first 10 pediatric LDLT at the Fattouma Bourguiba Hospital between November 2017 and March 2019. Results: The patients average age was 5 years and 11 months. The most common indication of LDLT was cirrhosis complicating PFIC. The average duration of mechanical ventilation was 1.8 days. One child developed hepatic artery thrombosis, another patient developed supra hepatic vein thrombosis. 2 patients developed acute rejection treated with immunosuppressant. The PICU length of stay ranged from 4 to 10 days and there was no ICU mortality. Challenges: - The Creation of liver transplant unit, - The Shortage of nursing staff was addressed by the participation of nurses from pediatric and adult ICU while awaiting the recruitment of more nurses, - The lack of experience of nurses in post- LT care necessitated to send few of them to Necker enfant malades to gain exposure to various aspects of LDLT, - The lack of Pediatric intensivist with expertise in LT was alleviated by the collaboration of pediatric intensivist from France. A daily staff by tele medicine guarantees the continuity of follow-up by the 2 teams. Conclusions: This study marks the successful development of a pediatric LT program in Tunisia. In the developing countries PICU care faces unique challenges in developing LDLT programs. Acknowledgements: We thank Christophe Chardot for his efforts and support in the inception of our transplant program

Do Not Delay: Safe Operation for Pediatric Living-donor Liver Transplantation Programs in the COVID-19 Era.

Do Not Delay: Safe Operation for Pediatric Living-donor Liver Transplantation Programs in the COVID-19 Era.

Early hepatic arterial thrombosis after pediatric living donor liver transplantation: a single-center experience.

Early hepatic arterial thrombosis after pediatric living donor liver transplantation: a single-center experience.

Examination of Usefulness of PELD Score for Pediatric Living Donor Liver Transplantation

Introduction: The PELD score is used for children younger than 12 years, but its usefulness has not been well reported. Thus, we examined whether the PELD score affects short-term and long-term outcome. Methods: Of the 85 cases of pediatric living donor liver transplantation (PLDLT) performed from July 1991 to August 2020, 58 cases in which PELD scores could be calculated retrospectively using medical records. Of these, group A with a PELD score of less than 10 (n=34) and group B (n=24) with a score of 10 or more were compared. Results: In 80% of all cases, the primary disease was biliary atresia. At the age PLDLT, group B was significantly younger than group A. Group B had significantly higher bleeding volume per body weight and intraoperative transfusion volume. Group B had a longer postoperative hospital stay and a lower overall survival rate than Group A, although this difference was not statistically significant. Postoperative rejection was common in group B. Five patients died postoperatively during the observation period., but there was no clear association with PELD score. Conclusion: In PLDLT, surgery tends to be performed before progression to end-stage liver failure. Especially for patients under one year old, jaundice after Kasai surgery often prolonged, and the PELD score tended to be relatively low. The PELD score seemed to have some usefulness in short-term outcomes. Although, there was no significantly difference in long-term outcome.

Donor Surgical Morbidity in Pediatric Living-Donor Liver Transplant: A Portuguese Experience.

PurposeLiving-donor liver transplant emerged as an alternative treatment for end stage liver disease due to the lack of cadaveric organs availability that met the demand. In Portugal, pediatric living-donor liver transplant (P-LDLT) was initiated in 2001 in Portugal in order to compensate for the scarcity of cadaveric organs for such cases. The aim of this study was to retrospectively analyze the morbi-mortality of the 28 donors included in P-LDLT program performed at Coimbra's Pediatric Hospital (CHUC), a Portuguese reference center.MethodsWe retrospectively collected pertinent donor data and stratified complications according to Clavien's scoring system.ResultsIn total, 28.6% (n=8) of the donors had surgical complications. According to Clavien-Dindo's classification, two donors had major complications (Clavien grade ≥3), four donors had grade 2 complications, and two donors had grade 1 complications. There were no P-LDLT-related mortalities in the present case series. The most common verified complications were biliary tract injuries and superficial incisional infections, which are consistent with the complications reported in worldwide series.ConclusionThese patients from CHUC shows that donor hepatectomy in P-LDLT is a safe procedure, with low morbidity and without mortality.

A Case Report on Tacrolimus Induced TTP and Early Use of Everlimus as Immunosuppressant in Pediatric Living Donor Liver Transplant

Objective: In this case report ,we describe our experience with Tacrolimus induced TTP in pediatric LDLT and early use of Everolimus as immuosupression. Method: Eight year old male child with DCLD due to cholesterol ester storage disorder Underwent LDLT .POD5 there was raised in bilirubin and thrombocytopenia(2.2 lakh to 20,000 /uL) ,elevated LDH (1660U/L ) and PS showed schistocytes (5-6%) F/S/O TTP .Patient developed seizures .MRI brain showed F/S/O PRESS. Tacrolimus was withheld .Patient was started on Retuximab therapy and he underwent 5 cycles of plasmapheresis. Gradually LFT's and Blood pictures normalized and patient was discharged on POD20. Thirteen year old male child presenting with cryptogenic cirrhosis underwent LDLT. POD 10 he developed seizures and hematuria. NCCT brain showed water shed area with infarcts. POD16 patient had elevated bilirubin , Thrombocytopenia ,PS showed Schistocytes .Patient underwent 3 cycles of plamapheresis.LDH and Schistocytes levels reduced .However we lost the child to sepsis on POD 30. Results: Diagnostic criteria for TTP include Severe thrombocytopenia30 X 10 9/L, Elevated LDH, Microangiopathic Hemolytic anemia,Schistocytes on the blood smear. Clinical presentation includes Brain 60% stroke, Heart ischemia 25%, Mesenteric ischemia 35% and Hematuria. Treatment includes plasmaphersis, steroids and Rituximab. Organ transplantation associated TTP is not the result of an immune-mediated ADAMTS13 deficiency and has the Worst prognosis. Conclusion: Very few cases of post LDLT with TTP has been mentioned in literature review. To best of our knowledge this is the only case in which Everolimus has been used as immunosuppressant early post op period in TTP.

Diaphragmatic Hernia after Pediatric Living Donor Liver Transplantation: An Indian Experience with Review of Literature.

Aim:Although intestinal obstruction following living donor liver transplantation (LDLT) is relatively common, diaphragmatic hernia (DH) as the attributing cause is rarely reported. The study aimed to find out the incidence, clinical presentation, and management of DH after liver transplant in pediatric patients.Materials and Methods:A retrospective review of all cases of pediatric liver transplants was performed. Case sheets, operation records, and investigations including radiology were studied.Results:Out of 79 cases of pediatric liver transplants, two cases of posttransplant DH were identified. The first case is a 2-year-old male child who was transplanted for progressive familial intrahepatic cholestasis, and the second one is a 4-year-old boy who underwent LDLT for hepatitis A-induced acute liver failure. The first child presented abdominal symptoms and the second one with pulmonary symptoms. The DHs were diagnosed at 132 and 70 days, respectively, posttransplant by chest radiographs and computed tomography scan. The defects were located at the posteromedial aspect of the diaphragm in both the cases and were closed by primary closure with mesh reinforcement. Both the children are doing well with no recurrence.Conclusion:High index of clinical suspicion is mandated in pediatric patients after liver transplant and once the diagnosis is confirmed, urgent surgical exploration is mandatory.

Pure Laparoscopic Donor Hepatectomy in Pediatric Living Donor Liver Transplantation: An Appraisal of the Safety and Efficacy of the Procedure

Objective: This study aimed to assess the safety of this procedure in children, including surgical complications and survival outcome following LDLT, to evaluate the effectiveness of open donor hepatectomy versus pure laparoscopic donor hepatectomy in a high-volume LDLT center. Methods: The medical records of 107 patients (aged ≤17 years) who underwent ABO compatible LDLT from May 2008 to June 2016 were analyzed. Of 107 patients, 76 underwent open donor hepatectomy and 31 underwent pure laparoscopic donor hepatectomy. To overcome bias from the differing distribution of co-variables among patients in the two study groups, a 1:1 propensity score matching analysis was performed using the nearest-neighbor matching method. Results: The mean follow-up period was 92.9 months in the open group and 92.7 months in the laparoscopic group. The length of post-operative hospital stay of the donor was statistically shorter in the laparoscopic group than in the open group. The overall surgical complication rate did not differ between the groups. The 1-, 3-, and 5-year overall survival rates were 93.6%, 93.6%, and 93.6% in the open group and 96.8%, 93.6% and 93.6% in the laparoscopic group, respectively. Conclusions: Laparoscopic hepatectomy may be more beneficial for the donor, and the use of laparoscopic methods on the donor does not adversely affect the recipient´s outcome. Thus, laparoscopic hepatectomy is a safe, feasible, and reproducible procedure for pediatric liver transplantation.

Post-transplant Lymphoproliferative Disorder in Recipient’s Reconstructed Middle Hepatic Vein After Pediatric Living Donor Liver Transplant: A Case Report

BackgroundPost-transplant lymphoproliferative disorder (PTLD) is known as one of the most frequent post-transplant neoplastic diseases, which may lead to recipient and graft morbidity after liver transplant. PatientA 14-year-old boy received pediatric living donor liver transplant (right living graft) 29 months ago, with etiology of biliary atresia. During 22-month follow-up after transplant, computed tomography and positron emission tomography with computed tomography scan showed a single progressive mass locating in the graft cutting surface with occlusive reconstructed middle hepatic vein (MHV). Serology was negative for Epstein-Barr virus serology. Mild fever and pneumonia did not improve after 1-week intravenous antibiotics. PTLD was considered. ResultsA surgical resection was scheduled and performed in compliance with the Helsinki Congress and the Istanbul Declaration. During laparotomy, a single mass located in the reconstructed MHV from segment V to the inferior vena cava was confirmed. Postoperative immunohistochemical result showed CD 3(+), CD 20(+), CD 38(+), CD 10(−), CD 56(−), Ki-67(+, 20%-30%), Epstein-Barr virus–encoded RNA(−), and Epstein-Barr virus nuclear antigen 2(−). Polymorphic PTLD was eventually diagnosed. No recurrence or new set lesions were detected after 6-month follow-up. ConclusionsThis is the first case describing PTLD may originate from reconstructed MHV after pediatric living donor liver transplant. As a life-threatening complication of liver transplant, surgical resection should be considered as a safe and feasible treatment for the single resectable mass.

Long-Term Safety and Efficacy of Pure Laparoscopic Donor Hepatectomy in Pediatric Living Donor Liver Transplantation.

Laparoscopic living donor hepatectomy for transplantation has been well established over the past decade. This study aimed to assess its safety and feasibility in pediatric living donor liver transplantation (LDLT) by comparing the surgical and long‐term survival outcomes on both the donor and recipient sides between open and laparoscopic groups. The medical records of 100 patients (≤17 years old) who underwent ABO‐compatible LDLT using a left lateral liver graft between May 2008 and June 2016 were analyzed. A total of 31 donors who underwent pure laparoscopic hepatectomy and their corresponding recipients were included in the study; 69 patients who underwent open living donor hepatectomy during the same period were included as a comparison group. To overcome bias from the different distributions of covariables among the patients in the 2 study groups, a 1:1 propensity score matching analysis was performed. The mean follow‐up periods were 92.9 and 92.7 months in the open and laparoscopic groups, respectively. The mean postoperative hospital stay of the donors was significantly shorter in the laparoscopic group (8.1 days) than in the open group (10.6 days; P < 0.001). Overall, the surgical complications in the donors and overall survival rate of recipients did not differ between the groups. Our data suggest that the laparoscopic environment was not associated with long‐term graft survival during pediatric LDLT. In addition, the laparoscopic approach for the donors did not adversely affect the corresponding recipient's outcome. Laparoscopic left lateral sectionectomy for living donors is a safe, feasible, and reproducible procedure for pediatric liver transplantation.

Laparoscopic left lateral sectionectomy in pediatric living donor liver transplantation by single-port approach: A case report

Laparoscopic left lateral sectionectomy in pediatric living donor liver transplantation by single-port approach: A case report

Technical Choices in Pediatric Living Donor Liver Transplantation: The Path to Reduce Vascular Complications and Improve Survival.

Pediatric living donor liver transplantation (PLDLT) is a successful therapeutic option for children with chronic and acute liver disease. After early transplant results, many technical advancements were introduced in the field to reduce the rate of complications and improve survival. The aim of this study is to present the outcomes of 975 primary PLDLTs in 3 periods: initial practice (period 1, 29 patients, January 1995 to December 1999), second period (period 2, 331 patients, January 2000 to December 2009), and third period (period 3 [P3], 615 patients, January 2010 to September 2019). Among the technical refinements introduced in P3 are the use of hyperreduced left lateral segment grafts, abdominal wall prosthetic mesh closure, double hepatic artery anastomosis, and increased use of vascular grafts for portal vein reconstruction. The outcomes included significant reductions of hepatic artery thrombosis (HAT), early portal vein thrombosis (EPVT), and retransplantation, with better patient and graft survival in P3. Additional analyses showed that the factors independently associated with worse 90-day patient survival were HAT, EPVT, and increasing Pediatric End-Stage Liver Disease score. In conclusion, the introduction of technical refinements in P3, in addition to improvements in patient care, determined a reduction in EPVT, HAT, and retransplantation. Consequently, patient and graft survival rates increased in all time points studied.

Bilioenteric Reconstruction Techniques in Pediatric Living Donor Liver Transplantation.

Biliary complications (BCs) are still a major cause of morbidity following liver transplantation despite the advancements in the surgical technique. Although Roux‐en‐Y (RY) hepaticojejunostomy has been the standard technique for years in pediatric patients, there is a limited number of reports on the feasibility of duct‐to‐duct (DD) anastomosis, and those reports have controversial outcomes. With the largest number of patients ever reported on the topic, this study aims to discuss the feasibility of the DD biliary reconstruction technique in pediatric living donor liver transplantation (LDLT). After the exclusion of the patients with biliary atresia, patients who received either deceased donor or right lobe grafts, and retransplantation patients, data from 154 pediatric LDLTs were retrospectively analyzed. Patients were grouped according to the applied biliary reconstruction technique, and the groups were compared using BCs as the outcome. The overall BC rate was 13% (n=20), and the groups showed no significant difference ( P =0.6). Stricture was more frequent in the DD reconstruction group; however, this was not statistically significant ( P =0.6). The rate of bile leak was also similar in both groups ( P =0.6). The results show that the DD reconstruction technique can achieve similar outcomes when compared with RY anastomosis. Because DD reconstruction is a more physiological way of establishing bilioenteric integrity, it can safely be applied.

Graft outflow vein venoplasty for a laparoscopically harvested left lateral section graft in pediatric living donor liver transplantation

Laparoscopically harvested left lateral section (LLS) grafts have drawbacks regarding the size of the graft left hepatic vein (LHV) orifice although they have the merit of cosmetics concerning the donor’s wound. We present a case of pediatric living donor liver transplantation (LDLT) using a laparoscopically harvested LLS graft and describe the refined surgical techniques for graft LHV venoplasty with a circumferential vein patch. The patient was a 46-month-old boy with marked growth retardation who was diagnosed with progressive familial intrahepatic cholestasis type 2. The donor was his 25-year-old mother. The LLS graft weighed 285 g. A circumferential patch of external iliac vein homograft was attached to the graft LHV orifice after incisions were made at the medial wall of the LHV trunk and superficial LHV branch, which made the graft LHV orifice much larger. The recipient’s hepatic vein orifice was also enlarged by unifying the three hepatic vein orifices. Other surgical procedures followed the standard LDLT operation. This patient recovered uneventfully and has been doing well for 1 year. In conclusion, our incision-and-patch venoplasty to enlarge the graft outflow vein orifice was beneficial for reducing the risk of hepatic vein outflow obstruction in LDLT using a laparoscopically harvested LLS graft.

Efficacy of intraoperative cine-portogram for complicated portal vein reconstruction in pediatric living donor liver transplantation.

Sufficient PV flow is necessary to achieve successful PV reconstruction in pediatric LDLT. IOCP can be used to assess the severity of PV stenosis and to identify potential portosystemic collateral pathways. The present study reviewed the utility of IOCP and the outcomes of patients who underwent assessment with an IOCP. Consecutive primary LDLTs were performed in 488 pediatric recipients between November 2005 and October 2019. IOCP was used in patients who were unable to achieve sufficient PV flow after the ligation of collaterals. In total, 11 patients underwent IOCP to assess potential portosystemic collateral pathways. The median age and body weight was 8months (IQR, 6-11months) and 6.6kg (IQR, 5.7-8.9kg), respectively. The reasons for using the IOCP were recurrent PV thrombus in seven patients and insufficient PV flow in four patients. IOCP revealed remaining collaterals in six patients and residual hypoplastic PV in eight patients. Two patients required additional interruption of the potential collaterals under IOCP, which were unable to be recognized as a dominant portosystemic collateral pathway on preoperative imaging. All eight patients with residual hypoplastic PV required vein graft interposition for the complete removal of the hypoplastic PV. All the patients are currently doing well with a median follow-up period of 4.9years (IQR, 2.2-5.6years). IOCP can be an effective tool for precisely detecting occult portosystemic collateral pathways and for assessing the patency of the PV anastomosis in pediatric LDLT.

CT BASED SARCOPENIA ASSESSMENT &amp; FRAILTY SCORES ARE BETTER THAN PELD IN PREDICTING EARLY MORBIDITY AND MORTALITY AFTER PAEDIATRIC LIVE DONOR LIVER TRANSPLANTATION

Background: There is limited evidence for the role of sarcopenia and frailty in predicting outcomes after pediatric living donor liver transplantation (pLDLT). Methods: Children (6months-10years) undergoing pLDLT for non-ALF indications at a single center between Jan2019 and August2019 were enrolled. CT scan was performed as part of pLDLT evaluation. Psoas muscle cross-sectional area on plainCT at L3 (PCSA) was measured. Severity of sarcopenia was reported as z- scores calculated by comparing with PCSA scores of age-matched healthy children who underwent CT for trauma or foreign-body ingestion. Frailty was assessed using both Lansky’s Play performance scale (LPPS) and Functional status score (FSS) via questionnaires administered to children or their carers. Clinical, peri-operative and outcome data was collected. Predictors of prolonged ventilation (>72 hours), major-morbidity (Clavien-Dindo score>2) and 90-day mortality were analysed. Results: 46 children were prospectively enrolled. Median (IQR) age, weight & PELD were 16mths(10,72), 9.2 kg (6.7,16.2), and 17(6,27.5). Median sarcopenia score was -1.42 (-2.26, -0.79). Median scores on LPPS and FSS scales were 60(40,90) & 6 (6,8.25). Median duration of post-op ventilation was 2 days (1,2.5). 24 (52.2%) children had atleast one post-op complication while 14 (30.4%) suffered major-morbidity. 5(10.9%) children died within 90 days. Predictors of major-morbidity on univariate analysis (UVA) were weight(p=0.007), sarcopenia (p=0.009), PELD(p=0.029) and GRWR(p=0.028). Multivariate analysis (MVA) identified sarcopenia as the only independent factor (odds ratio 0.589 (95%ci 0.384,0.903), p=0.015). Factors associated with prolonged ventilation were etiology, weight, sarcopenia, LPPS & FSS scores. On MVA, sarcopenia (odds ratio: 0.581 (95%ci 0.361,0.934), p=0.025) and LPPS (odds ratio: 0.952 (95%ci 0.910-995), p=0.029) were identified as independent factors. Predictors of post-op mortality were etiology, age, sarcopenia & FSS. On MVA, sarcopenia (odds ratio- 1.934 (95% ci- 1.147, 3.260), p=0.013) alone predicted 90-day post-op mortality. Conclusion: Sarcopenia and frailty are promising predictors of early outcomes after pLDLT.