*Purpose: The developmental characteristics and hemodynamics of pediatric liver allografts transplanted into adult recipients remain unclear and deserve exploring.

*Methods: Records from adult recipients undergoing liver transplantation between January 2015 and December 2019 who received whole grafts from pediatric (<14 years, Experimental group) or adult (18-35 years, Control group) donors were reviewed.

*Results: The study comprised 312 subjects, divided between the pediatric (n = 67) and adult donor (n = 245) groups. The 1, 3 and 5-year recipient survival rates were 87.3%, 83.3%, and 83.3% in the pediatric group, and 88.6%, 85.7%, and 85.7% in the adult group. One adult recipient receiving a pediatric allograft developed small-for-size liver syndrome (SFSS) post-transplantation. There was no difference in the incidence of portal vein thrombosis, biliary complications, primary graft non-function, or prolonged cholestasis between the two groups. As expected, the recipients in the pediatric group had a lower graft-to-recipient weight ratio (GRWR) (1.16±0.32) and graft weight (GW)/ estimated recipient liver weight (ERLW) (0.73±0.23) than the adult group (2.25±1.70, 1.45±0.40, p<0.01). Evaluation at 1 year from transplant demonstrated that the recipient's right hepatic oblique diameter, diameter of main portal vein (DPV) and resistance index (RI) were not significantly different between the two groups (P>0.05). The velocity of the main portal vein (VPV) and velocity of Hepatic artery (VHA) in the pediatric group was almost always higher than the adult group throughout the first year of transplantation, but eventually all returned to normal range.

*Conclusions: The pediatric donor liver can be successfully used in adult recipients with well-matched conditions. There were no significant differences in postoperative hemodynamics and the grafts developed and functioned normally.

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