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Background As a result of improved outcomes, referral to pediatric liver transplant (PLT)services has gradually increased but unfortunately graft pool did not show similar expansion resulting in graft shortage. Identifying the pre-transplant predictors of patient and graft survival can help in more effective graft allocation and can be crucial in guiding medical care and re-listing decisions. Aim Identifying pre-transplant factors that can by itself or in combination predict post-transplant patient and graft survival. Methods This is a retrospective review of PLT episodes in Leeds Teaching Hospitals NHS trust from 2000 to 2020.Univariate and Multivariate analysis of pre-transplant factors were used to identify predictors of patient and graft survival. We classified aetiology of liver disease into 6 broad categories: End stage chronic liver disease (ESCLD),Acute liver failure (ALF),acute on top of ESCLD, metabolic liver disease, tumours and re-transplantation. Grafts used were divided into whole and technical variant grafts where technical variant grafts include all split and reduced grafts, technical variant grafts were further divided into grafts from cadaveric or living donors (LD). Results 276 patients in our centre received 320 LTs. ESCLD was the main indication (60.6%) followed by re-transplantation (13.7%), ALF (10.3%), tumours (8.8%), metabolic (5.3%) and acute on top of ESCLD (1.3%). Source of liver grafts were DBD donors in 271 (84.7%) transplant episodes while 49 grafts (15.3%) were from living donors. Number of grafts per patient was one graft in 276 patients (86.2%), two grafts in 39 patients (12.2%) and three grafts in 5 (1.6%) patients. Recipients who required pre-transplant mechanical ventilation were 24 (7.5%)recipients 0.44(13.8%) patients required re-transplantation. Most common cause of graft loss was hepatic artery thrombosis (HAT) in 13 re-transplants (29.6%). At the end of study, 239(86.6%) recipients survived while 37 (13.4%) died. Most common cause of death was sepsis. Univariate analysis for patient survival (table 1) showed that following variables had a significant (p Summary This study, spanning over about 20 years, represents one of the biggest UK based PLT single centre reports. Only significant factor for patient and graft survival was era of transplant with PLT after 2010 has significantly better patient and graft survival. Conclusion Building experience has substantial effect on patient and graft survival. Traditional view of worse outcomes of smaller candidates should be changed especially in high volume centres with prolonged experience.

Introduction The UK has been severely affected by the COVID-19 pandemic. The impact on the adult population has been disproportionately higher when compared to children with consequent challenges to organ donation and liver transplantation (LT). Across the three UK paediatric liver centres there has only been a very small number of patients who tested positive for COVID-19 and all made a speedy and full recovery. We report here the response during the pandemic across the 3 paediatric LT centres. Methods A series of nationally agreed policy changes affecting the liver procurement, listing and transplant process were agreed during regular meetings with LT centre directors and NHSE. Actions at a local and national level were agreed to protect and maintain the paediatric LT programmes. Data were collected from 27/03/20 until 26/11/20 and compared with same time period for the years 2016–19. Results During the study period, there was a significant reduction in the adult population in the mean number of weekly liver offers, donors and LTs compared to before the pandemic with signs of recovery between the 1st and 2nd UK lockdown periods (figure 1). More specifically the number of livers offered nationally was reduced from an average 30–40/week to only Overall, 65–80 paediatric LTs are performed annually across the UK’s 3 paediatric centres. From March-November 2020 there were 58(82%) elective and 13(18%) super urgent (acute liver failure & hepatoblastoma) paediatric LTs performed. Donor Brain Dead (DBD) and Donor Cardiac Dead (DCDC) LTs were 54(76%) and 3(4%), respectively. Living related LT (LRLT) programme was sustained comprising 20% of LTs performed. The number of paediatric LTs performed during the pandemic was comparable to those performed yearly since 2016. The number of LT per paediatric centre for King’s College Hospital (KCH), Birmingham Children’s Hospital (BCH) and Leeds Liver Unit were 40 (56%), 15(21%) and 16(23%), respectively with excellent outcome. A 15-year-old girl from KCH diagnosed with Wilson disease presented with liver failure and became COVID-19 positive whilst listed. She underwent LT soon after becoming COVID-19 negative. No perioperative mortality was reported with excellent outcome so far in all. Conclusion The current COVID-19 pandemic had a significant impact on the UK adult LT programme. The paediatric programme LT was preserved despite a decrease in organ offering and retrieval nationally plus limitations on adult intensive care resources at a regional level. Overall, paediatric LT outcome remained very good.