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To systematically evaluate the prognostic impact, clinical risk factors, and immunological features of RA, we retrospectively analyzed 1455 pediatric recipients who received LT in Renji Hospital between October 2016 and December 2021. RA was associated with increased mortality and graft loss after pediatric LT. Univariate analysis identified 13 clinical factors associated with RA, whereas a preliminary multivariable model showed only moderate discrimination, suggesting substantial heterogeneity among RA patients. Based on unsupervised clustering of clinical parameters, RA individuals were classified into two subgroups. Type I ascites was mainly associated with low graft\u2010to\u2010recipient weight ratio, decreased preoperative white blood cell count, and platelet count, indicating the involvement of persistent portal hypertension. In contrast, type II ascites was characterized by ABO incompatibility, elevated early postoperative soluble IL\u20102 receptor, and increased risk of T\u2010cell\u2010mediated rejection, suggesting excessive alloimmune activation. These findings indicate that RA after pediatric LT comprises distinct clinical entities with different pathogenic implications. Prudent graft selection and close monitoring of immune status may help prevent RA and improve post\u2010transplant outcomes.<\/jats:p>","DOI":"10.1002\/mco2.71002","type":"journal-article","created":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T06:56:22Z","timestamp":1789196182000},"source":"Crossref","is-referenced-by-count":0,"title":["Clinical Heterogeneity of Refractory Ascites After Pediatric Liver Transplantation Modulates Allograft Rejection Risk"],"prefix":"10.1002","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8515-5137","authenticated-orcid":false,"given":"Bingran","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Liver Surgery Renji Hospital Shanghai Jiao Tong University School of Medicine  Shanghai People's Republic of China"},{"name":"Shanghai Institute of Transplantation Renji Hospital Shanghai Jiao Tong University School of Medicine  Shanghai People's Republic of 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