*Purpose: To review the multi-center US experience with liver transplantation (LT) for Biliary Atresia (BA)

*Methods: We reviewed LT outcomes in children with BA in the 2018 update to the US Scientific Registry for Transplant Recipients (SRTR), and the US live birth data in the 2015 update prepared by the Center for Disease Control (CDC).

*Results: 5476 children with BA received LT, at a median (range) rate of 177 (33-200) LT each year between 1987-2018. Live births in the US averaged 4.02 million (range 3.85 to 4.31 million) between 1990-2015. The incidence of BA requiring LT averaged one per 22709 live births. Compared with the pre-2000 period, the post-2000 period witnessed i) more LT for BA, 3229 vs 2227 ii) greater 15-year graft (80% vs 62%, p<0.001) and patient survival (91% vs 81%, p<0.001, K-M test) iii) fewer deaths at 30 days, 1 year and >1-year post-LT (3%, 1%, and 2% vs 6%, 5% and 8% p=0.0001). Stratified further by four chronological decades, segmental LT and living donor use increased, while re-LT decreased significantly (p<0.001, Table 1). Also seen were an increase in LT for Hispanic children with BA (SRTR) and increased live births among US Hispanics (H), relative to white (W) and black (B) populations (CDC).

*Conclusions: Survival after LT for BA has improved and increasingly relies on segmental grafts. The relative increase in LT among Hispanic BA recipients is associated with relative increase in live births of US Hispanic ethnicity.

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