Background: Pediatric liver transplantation lies at the epitome of liver transplantation(LT) and pediatric surgery. A successful paediatric LT (PLT) unit requires a fluidic coordination between several verticals of a hospital. Given that only a few units across the world perform over 50 PLT per year, in 2022 we performed 100 PLT, a 60% increase in PLT from the past year. We discuss the logistic frameworks which enabled us to achieve this number and we looked at clinical outcomes compared to the previous year.

Materials and methods: A retrospective analysis of all LT in children (<18 years ) for the year 2021 & 2022 was done for demographic features, indications and graft profile and survival as primary outcome. T test was used to compare continuous variables and Fisher exact test was used for categorical variables

Results: From Jan 2011  to dec 2022 , a total of 583 PLT were performed. For the year 2021, 63  PLT were performed and for the year 2022, 102 PLT were performed, the demography and the outcomes are outlined in the table one. The indication for LT are biliary atresia 44%(n=44), monogenic disorders accounted for 37% ( n=37), and  others accounted for the rest. Three were split LT from deceased donor and rest were live donors. 10 children had ABO incompatable LT. Even though the children were younger and weighed less in the 2022 cohort the outcomes were comparable to past years. Only one child required a re-transplantation. The overall 90-day mortality was 98.5%.

Conclusions:  We show that with coordinated multidisciplinary team, 100 PLT, an increase of 60% is achievable with excellent outcomes. It was also noteworthy that these children were younger and weighed less than those from the previous year.