Background: Pediatric liver transplantation (LT) in Korea has improved in outcomes over the years, but the overall volume has declined since the 2010s. This study examines trends, outcomes, and the impact of allocation policies on pediatric LT in Korea.
Methods: A retrospective analysis of data collected from four high-volume pediatric transplant centers in Korea from 2010 to 2024 was conducted. Demographics, transplant indications, donor types, and survival outcomes were evaluated. Graft and patient survival rates were analyzed across different periods, and the impact of DD liver allocation on pediatric recipients was assessed.
Results: A total of 748 pediatric LTs were performed at four Korean centers, representing 94.3% of national cases. The median recipient age was 2.0 years, with a mean of 5.86 years. Retransplantation rates increased to 9.8% (73/748) compared to 6% (32/504) in the previous decade. Graft survival rates at 1, 3, 5, and 10 years were 90.0%, 87.0%, 85.8%, and 83.7%, respectively. Patient survival rates were 92.6% at 1 year, 90.1% at 3 years, 89.6% at 5 years, and 88.6% at 10 years. The proportion of deceased donor liver transplantation (DDLT) declined, with living donor liver transplantation (LDLT) accounting for 60% of cases. Split liver transplantation from DDs remained limited. Current organ allocation policies do not prioritize pediatric candidates, leading to adult recipients receiving most pediatric DD livers.
Conclusion: Pediatric LT outcomes in Korea have improved, but the declining trend in DDLT and restrictive allocation policies limit access for pediatric recipients.