{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:08:17Z","timestamp":1782864497864,"version":"3.54.5"},"reference-count":28,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T00:00:00Z","timestamp":1765152000000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>As short\u2010term outcomes following pediatric liver transplantation improve, an increasing burden of morbidity arises from chronic graft dysfunction warranting retransplantation. In this single\u2010center retrospective cohort study, we aim to describe outcomes and determine factors that influence morbidity and mortality following liver retransplantation in pediatric recipients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data were collected on patient, and surgical factors which may influence survival and morbidity in all recipients &lt;\u200918\u2009years of age undergoing liver retransplantation between 2010 and 2024. Retransplants within 21\u2009days were defined as early retransplants. For late retransplants, medical records were additionally reviewed to identify cases transplanted with acute decompensation of liver disease with organ failures. These cases were classified according to EASL\u2010CLIF criteria for acute\u2010on\u2010chronic liver failure (ACLF).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>\n                      Forty\u2010four children underwent 52 retransplants with six third grafts and two fourth grafts. Sixteen were early retransplants with 9 (56.33%) due to vascular complications and the remaining primary non\u2010function. Thirty\u2010six were late retransplants with 13 (36.1%) due to chronic rejection and 13 (36.1%) due to biliary complications. Eight (22.2%) late retransplants fulfilled ACLF criteria. Patient survival for all retransplants at 1\u2010, 5\u2010 and 10\u2010year was 75% (95% CI: 64.1%\u201387.7%), 69.1% (95% CI: 57.6%\u201382.9%), 64.8% (95% CI: 51.9%\u201380.9%) and graft survival was 70.0% (95% CI: 58%\u201385.3%), 57% (95% CI: 43%\u201374.4%), 46% (95% CI: 32%\u201368.5%) respectively with no significant difference in survival for early versus late retransplants. Factors significantly associated with reduced retransplant survival for late retransplants were preoperative renal replacement therapy (HR: 3.80, 95% CI: 1.09\u201313.28,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.04), meeting criteria for ACLF (HR: 3.08, 95% CI: 1.14\u20138.31,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.03), and prolonged warm ischemia time (HR: 1.24, 95% CI: 1.09\u20131.67,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.04). No significant perioperative factors reducing posttransplant survival were identified for early retransplants.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Children with chronic graft dysfunction are at risk of ACLF which is associated with significant increased posttransplant mortality. Improved disease models are needed for patients with chronic graft dysfunction to better inform decision\u2010making regarding the timing of retransplantation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/petr.70236","type":"journal-article","created":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T06:41:51Z","timestamp":1765262511000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Late\u2010Onset Graft Failure in Pediatric Liver Transplant Recipients: Implications of Acute\u2010on\u2010Chronic Liver Failure on Retransplantation Outcomes"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6700-1890","authenticated-orcid":false,"given":"V.","family":"Rajasekaran","sequence":"first","affiliation":[{"name":"Liver Unit Birmingham Children's Hospital  Birmingham UK"},{"name":"School of Medicine and Public Health University of Newcastle  Newcastle, New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Bueno Jimenez","sequence":"additional","affiliation":[{"name":"Liver Unit Birmingham Children's Hospital  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Hartley","sequence":"additional","affiliation":[{"name":"Liver Unit Birmingham Children's Hospital  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2703-8423","authenticated-orcid":false,"given":"K.","family":"Sharif","sequence":"additional","affiliation":[{"name":"Liver Unit Birmingham Children's Hospital  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.","family":"Vilca\u2010Melendez","sequence":"additional","affiliation":[{"name":"Liver Unit Birmingham Children's Hospital  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Gupte","sequence":"additional","affiliation":[{"name":"Liver Unit Birmingham Children's Hospital  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,12,8]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/lt.500050505"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007890-200210270-00012"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja2.50802"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.14699"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.14092"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000004500"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1477-2574.2010.00162.x"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1053\/jpsu.2001.23963"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.16932"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.21152"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/lt.23748"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/tri.13956"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2023.04.021"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-023-04540-4"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007890-200101150-00015"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/lt.25719"},{"key":"e_1_2_6_18_1","unstructured":"M.Jacobs R.Taylor andS.Phillips \u201cAnnual Report on Liver Transplantation (1 April 2013\u201331 March 2023)\u201d(2023) NHS Blood and Transplamt; 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