*Purpose: We determined to find out the utilization rate of pediatric livers, identify risk factors for graft discard and analyse the outcomes of adult liver transplants using pediatric livers.

*Methods: We used data from the Scientific Registry of Transplant Recipients database from January 1, 2000 to November 31, 2015. The trends of pediatric liver donors and utilization rates were analyzed. Donor risk factors that impacted the graft use of pediatric livers were measured. Logistic regression modelling was performed to evaluate graft utilization and risk factors. For clinical outcome, we used the data from our center. Records from adult recipients undergoing liver transplant between February 2011 and January 2016 who received whole grafts from paediatric (≤ 18 years) donors and deceased adult (>18 years) donors were collected and analysed. Clinical outcomes and complications were compared between the two groups.

*Results: For utilization analysis, we identified 14506 applicable deceased liver allograft donors under 18 years of age in the database. The number of deceased pediatric liver donors was greater than 900 from 2000 to 2007 and peaked in 2006. The number dropped below 900 in 2008 and decreased each subsequent year until 2012. Only 748 deceased pediatric liver allografts were consented in 2012. Then the number rose slightly from 2013 to 2015. A total number of 1321 authorized liver grafts were not recovered or recovered without transplantation. A total of 152 consented pediatric donors were unutilized in 2000, which corresponds to 15.4% of all donors. The number of unutilized pediatric liver donors declined annually.

Based on the multivariate analysis, factors including donation in the years of 2000-2005, death of anoxia (OR=1.392, p=0.038), lack of heartbeat (OR=1.883, p=0.032), HBsAg positivity (OR=4.810, p=0.001) total bilirubin >1 mg/dl (OR=1.263, p=0.002), Creat >1.5g/l (OR=1.692, p=0.018) and BUN >21 mg/dl (OR=1.740, p=0.017) were significantly related to graft non-utilization. For clinical outcomes analysis ,we found that most baseline demographics of recipients were comparable. It was not surprising that pediatric donor livers were much smaller in size. The 3-month, 1-year, and 3-year recipient survival rates were 92%, 85%, and 82% in the pediatric donor group, which were not significantly different from adult donor group (93%, 87%, and 83%, P=0.863). Three recipients receiving a pediatric livers developed small-for-size liver syndrome post-transplantation. There was no difference in early allograft dysfunction, primary non-function, biliary complications, vascular complications between the two groups.

*Conclusions: The pediatric liver allograft utilization rate and risk factors for non-utilization of grafts were determined. Using pediatric donor livers in well-selected adult recipients is a safe procedure.

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