Factors Influencing 25‐Year Survival in Pediatric Liver Transplant Recipients

Background This study assesses the impact of cholestatic liver disease, including biliary atresia, on 25‐year survival post‐transplantation and additional factors influencing long‐term outcomes after pediatric liver transplantation. Methods We conducted a retrospective analysis of pediatric liver transplant recipients (1987–1998) using de‐identified data from the OPTN 2023 Liver Database. After exclusions for multi‐organ transplants ( n = 222), prior transplants ( n = 2256), and deaths within 1 year ( n = 526), 2429 patients remained, including 645 with cholestatic disease. Univariate and multivariate analyses identified factors associated with 25‐year survival. Results A primary diagnosis of cholestatic disease was associated with improved 25‐year survival (OR: 0.67, p = 0.023). UNOS regions 2 (OR: 0.65, p = 0.009) and 5 were also associated with improved survival (OR: 0.72, p = 0.044). Decreased survival was associated with recipient ages 8–12 (OR: 1.84, p = 0.009) and 12–18 (OR: 2.90, p = 0.003), donor age ≥ 19 (OR: 1.42, p = 0.021), African‐American (OR: 1.94, p = 0.000) and other minority recipient ethnicities (OR: 2.49, p = 0.018), donor bilirubin ≥ 2 mg/dL (OR: 1.85, p = 0.022), and UNOS region 10 (OR: 1.62, p = 0.009). Conclusion This study evaluates 25‐year survival in pediatric liver transplant recipients while analyzing the protective influence of a cholestatic disease diagnosis. Older recipient and donor ages, minority recipient ethnicities, elevated donor bilirubin, and specific UNOS regions are associated with decreased 25‐year survival. Further research is needed to address outcome inequalities.