{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T09:07:00Z","timestamp":1788858420811,"version":"build-2803163510"},"reference-count":37,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T00:00:00Z","timestamp":1780617600000},"content-version":"vor","delay-in-days":4,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2026,6]]},"abstract":"ABSTRACT<\/jats:title>\n \n Introduction<\/jats:title>\n \n Biliary atresia (\n BA<\/jats:styled-content>\n ) is the most common indication for pediatric liver transplantation. Pediatric end\u2010stage liver disease (\n PELD<\/jats:styled-content>\n ) scores primarily determine deceased donor liver transplant (\n DDLT<\/jats:styled-content>\n ) waitlist priority. Due to persistent donor supply\u2013demand mismatch, children typically have advanced disease and high\n PELD<\/jats:styled-content>\n scores at the time of\n DDLT<\/jats:styled-content>\n . Proactive living donor liver transplant (\n LDLT<\/jats:styled-content>\n ) may facilitate transplantation before critical illness. We hypothesized that early, low\n PELD<\/jats:styled-content>\n ,\n LDLT<\/jats:styled-content>\n is associated with improved graft and patient survival in children with\n BA.<\/jats:styled-content>\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n We retrospectively reviewed children undergoing liver transplantation for\n BA<\/jats:styled-content>\n in the\n SRTR<\/jats:styled-content>\n database, comparing\n DDLT<\/jats:styled-content>\n to\n LDLT<\/jats:styled-content>\n , stratified by\n PELD<\/jats:styled-content>\n . Early transplant was defined as transplant with a\n PELD<\/jats:styled-content>\n \u2264\u200912. Four groups were analyzed: low\n PELD LDLT<\/jats:styled-content>\n , low\n PELD DDLT<\/jats:styled-content>\n , high\n PELD LDLT<\/jats:styled-content>\n , and high\n PELD DDLT<\/jats:styled-content>\n . Kaplan\u2013Meier and Cox\u2010proportional hazards analyses evaluated patient\u2010 and graft\u2010survival.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n 4733 children meeting inclusion criteria were included (\n n<\/jats:italic>\n \u2009=\u2009249 Low PELD LDLT,\n n<\/jats:italic>\n \u2009=\u20091152 Low PELD DDLT,\n n<\/jats:italic>\n \u2009=\u2009708 High PELD LDLT,\n n<\/jats:italic>\n \u2009=\u20092624 High PELD DDLT). Prior to transplant, Low PELD LDLT recipients had lower INR and bilirubin levels, and required less life support (\n p<\/jats:italic>\n \u2009<\u20090.01). Kaplan\u2013Meier analyses showed the highest 5\u2010year graft and patient survival in the Low PELD LDLT (\n p<\/jats:italic>\n \u2009<\u20090.01). Cox modeling revealed an independent association between low PELD LDLT and decreased graft loss (adjusted HR 0.45,\n p<\/jats:italic>\n \u2009<\u20090.01) and mortality (adjusted HR 0.43,\n p<\/jats:italic>\n \u2009=\u20090.03).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n A proactive approach to\n LDLT<\/jats:styled-content>\n in children with\n BA<\/jats:styled-content>\n is associated with improved long\u2010term graft and patient survival. Low\n PELD LDLT<\/jats:styled-content>\n should be considered to increase early transplant access for children with\n BA<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/petr.70367","type":"journal-article","created":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T06:29:04Z","timestamp":1780727344000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Early Living Donor Liver Transplant Is Associated With Improved Graft\u2010 and Patient\u2010Survival Outcomes in Children With Biliary Atresia"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7387-0830","authenticated-orcid":false,"given":"Marshall W.","family":"Wallace","sequence":"first","affiliation":[{"name":"Division of Pediatric Surgery, Department of Surgery University of Utah Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2435-2268","authenticated-orcid":false,"given":"Cameron M.","family":"Arkin","sequence":"additional","affiliation":[{"name":"Division of Pediatric Surgery, Department of Surgery University of Utah Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0934-056X","authenticated-orcid":false,"given":"Anastasia M.","family":"Kahan","sequence":"additional","affiliation":[{"name":"Division of Pediatric Surgery, Department of Surgery University of Utah Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9088-6631","authenticated-orcid":false,"given":"Chinedu","family":"Nwaduru","sequence":"additional","affiliation":[{"name":"Division of Pediatric Surgery, Department of Surgery University of Utah Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9272-5618","authenticated-orcid":false,"given":"Francisca","family":"van der Schyff","sequence":"additional","affiliation":[{"name":"Division of Pediatric Surgery, Department of Surgery University of Utah Salt Lake City Utah USA"},{"name":"Primary Children's Hospital, Intermountain Health Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8411-4800","authenticated-orcid":false,"given":"Jean F.","family":"Botha","sequence":"additional","affiliation":[{"name":"Primary Children's Hospital, Intermountain Health Salt Lake City Utah USA"},{"name":"Intermountain Medical Center, Intermountain Healthcare Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2561-7539","authenticated-orcid":false,"given":"Zachary J.","family":"Kastenberg","sequence":"additional","affiliation":[{"name":"Division of Pediatric Surgery, Department of Surgery University of Utah Salt Lake City Utah USA"},{"name":"Primary Children's Hospital, Intermountain Health Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,5]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajt.2023.02.006"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2021.12.027"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2013.01.040"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2018.3180"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/lt.23667"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2018.2541"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.70031"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/lt.24796"},{"issue":"3","key":"e_1_2_9_10_1","first-page":"367","article-title":"Reduced\u2010Sized Orthotopic Liver Graft in Hepatic Transplantation in Children","volume":"95","author":"Bismuth H.","year":"1984","journal-title":"Surgery"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658\u2010199009000\u201000015"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007890\u2010198803000\u201000003"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/LVT.0000000000000613"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.13318"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007890\u2010200108150\u201000018"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600\u20106143.2004.00359.x"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.140.5.465"},{"key":"e_1_2_9_18_1","unstructured":"Scientific Registry of Transplant Recipients Request for Information. 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