*Purpose: Our institution, a freestanding pediatric hospital (FPH) has a large pediatric liver transplant (LT) experience. Our aim was to analyze our experience with other FPHs and compare it to the UNOS experience.

*Methods: We analyzed 551 children listed for and 528 recipients of LT at our institution between 1987-2016 and the UNOS database which included 5,273 children listed / 4,959 children transplanted in FPHs and 18,090 children listed / 10,832 children transplanted in other settings. Kaplan-Meier and multivariate analyses were performed.

*Results: Our institution achieved pediatric LT survivals of 91% 1-year, 87% 5-year, 84% 10-year, and 77% 20-year survival compared to 85% 1-year, 79% 5-year, 76% 10-year, and 68% 20-year survival at non-FPHs (p<0.001). Our institution and other FPHs had superior waitlist survival, probability of transplant, and posttransplant survival compared to children treated at non-FPHs (p<0.001). After adjusting for age, diagnosis, GFR, height, serum albumin, listing status, PELD score, serum sodium, and weight, pediatric LT performed in a FPH has a 67% decreased chance of dying pretransplant and a 16% increased chance of surviving LT.

*Conclusions: We report one of the largest institutional experiences in pediatric LT and demonstrate that superior patient survival, probability of transplant and waitlist mortality are achieved at our institution and other FPHs.

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