*Purpose: Galectin-3 (Gal3) is a beta-galactoside binding lectin that plays a key role in inflammation and immune response. Infectious complications are common among pediatric liver transplant recipients due to immunosuppression, critical illness, and biliary complications. The aim of this study was to investigate if Gal3 level at time of transplant is associated with post-transplant infection in pediatric liver transplant recipients.

*Methods: Plasma was collected from children undergoing liver transplantation at our institution at time of transplant. Gal3 was measured using standard ELISA. The primary outcome of interest was infectious complication, defined as any infection in the post-transplant period that was laboratory confirmed or empirically treated based on clinical findings. Logistic regression was used to measure the association between Gal3 and infection.

*Results: Plasma was collected from 23 children at time of liver transplant. 17 (74%) of recipients had a post-transplant infection. There were no significant differences in baseline characteristics among those with and without an infectious complication (Table 1). Recipients who later developed an infectious complication had significantly higher Gal3 at time of transplant than those who did not (Figure 1). Gal3 level was significantly predictive of post-transplant infection (odds ratio 1.24, 95% confidence interval 1.02 – 1.52, area under the curve = 0.86, p = 0.03).

*Conclusions: Infection is a common complication among pediatric liver transplant recipients. Gal3 at time of transplant is highly predictive of this complication. Elevated Gal3 may signify a vulnerable immune state that when combined with immunosuppression and other stressors of liver transplant, predisposes children to infectious complications. A novel biomarker such as Gal3 that is available at time of transplant may help risk stratify which recipients would benefit from increased post-transplant infection prophylaxis.

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