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Background: We examined the combined effects of donor age and graft type on pediatric liver transplantation outcomes with an aim to offer insights into the strategic utilization of these donor and graft options. Methods: A retrospective analysis was conducted using a national database on 0–2‐year‐old (N = 2714) and 3–17‐year‐old (N = 2263) pediatric recipients. These recipients were categorized based on donor age (≥40 vs <40 years) and graft type. Survival outcomes were analyzed using the Kaplan–Meier and Cox proportional hazards models, followed by an intention‐to‐treat (ITT) analysis to examine overall patient survival. Results: Living and younger donors generally resulted in better outcomes compared to deceased and older donors, respectively. This difference was more significant among younger recipients (0–2 years compared to 3–17 years). Despite this finding, ITT survival analysis showed that donor age and graft type did not impact survival with the exception of 0–2‐year‐old recipients who had an improved survival with a younger living donor graft. Conclusions: Timely transplantation has the largest impact on survival in pediatric recipients. Improving waitlist mortality requires uniform surgical expertise at many transplant centers to provide technical variant graft (TVG) options and shed the conservative mindset of seeking only the "best" graft for pediatric recipients. [ABSTRACT FROM AUTHOR]

The demand for kidney transplant is quite high compared with the current supply, even with the increasing numbers of transplant deceased donors since 2019.6 Pediatric kidney-alone and multiple organ transplant candidates compete for the same high-quality donor kidneys, but under the current OPTN allocation policy multiple organ transplants have ultimate priority. During the study period, children receiving kidney-alone transplants had the highest one-year graft survival (98.2%) compared with K-P (96.6%) and other multiple organ transplants (87.9%-88.2%). Although the OPTN/UNOS has a well-defined history of giving priority to children, it has not yet begun to address in policy the multiple organ transplant effect on pediatric priority due to the perceived complexity of multiple organ allocation. [Extracted from the article]