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Additionally, the present study aimed to identify factors associated with SWE-derived parameters.Methods: This study retrospectively analyzed pediatric LT recipients who had received a left lobe or left lateral segment graft during childhood and underwent paired 2D SWE and liver biopsy. Associations between elasticity and dispersion slope measurements and clinicopathologic parameters were evaluated using univariable and multivariable regression analyses. Subgroup analyses were performed according to sonographic approach and age group. Diagnostic performance was assessed using receiver operating characteristic analysis.Results: A total of 108 patients (median age, 13.4 years; 47 males) were included. Elasticity measured using the intercostal approach in patients aged \u226513 years showed significant associations with METAVIR (Meta-analysis of Histological Data in Viral Hepatitis) fibrosis grade, necroinflammatory activity grade, liver allograft fibrosis score, and rejection activity index score. In multivariable analysis incorporating clinical parameters, METAVIR fibrosis grade remained the only independent predictor of intercostal elasticity in this age group (coefficient, 2.17; P&amp;lt;0.001). Intercostal elasticity demonstrated excellent diagnostic performance for distinguishing F0\u2013F2 from F3\u2013F4 fibrosis (area under the curve [AUC], 0.95; P&amp;lt;0.001; cut-off, 11.0 kPa) and good performance for distinguishing F0\u2013F1 from F2\u2013F4 fibrosis (AUC, 0.83; P&amp;lt;0.001; cut-off, 7.2 kPa). In contrast, subcostal measurements and dispersion slope showed no significant association with any pathologic parameter.Conclusion: Intercostal elasticity demonstrated diagnostic value for predicting graft fibrosis in pediatric LT recipients aged \u226513 years who received left lobe or left lateral segment grafts. Among the evaluated clinicopathologic parameters, METAVIR fibrosis grade was the only independent predictor of elasticity in this subgroup.<\/jats:p>","DOI":"10.14366\/usg.25237","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T05:55:03Z","timestamp":1782798903000},"page":"381-392","update-policy":"https:\/\/doi.org\/10.14366\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Two-dimensional elastography and dispersion slope for allograft evaluation after pediatric liver transplantation"],"prefix":"10.14366","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-0335-6903","authenticated-orcid":true,"given":"Jeong Min","family":"Song","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6325-3548","authenticated-orcid":true,"given":"In 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