*Purpose: The aim of this study was to compare pediatric liver transplant (pLT) waiting list and post-transplant outcomes by center pediatric living donor liver transplant (pLDLT) volume.

*Methods: The UNOS database was retrospectively reviewed for all children listed for pLT from March 2002 through December 2017. High pLT volume was defined as > 100, medium volume as 10 – 99, and low volume as < 10 pLT during the study period. High LDLT volume was defined as > 10, low LDLT volume as 1-9, and no LDLT as zero LDLT performed during the study period.

*Results: 9,767 pediatric candidates were listed for pLT and 7,136 pLT were performed during the study period, with 928 (13%) pLDLT. 26 centers were high, 37 were medium, and 40 low pLT volume. 23 centers were high pLDLT volume, 33 were low pLDLT volume, and 47 performed no pLDLT. 17 of the 26 (65%) high pLT volume centers were also high pLDLT volume. Upon multivariable Cox regression, high pLDLT volume was significantly protective against waiting list mortality, independent of center pLT volume (adjusted HR 0.78, 95%CI 0.63 – 0.96, p = 0.02). Post-pLT recipient and graft survival was significantly greater at high pLDLT volume centers in comparison to centers with low and no pLDLT volumes (Figures 1 & 2).

*Conclusions: Pediatric transplant centers with high living donor liver transplants volumes achieve superior waiting list and post-transplant survival outcomes, independent of overall pediatric liver transplant volume.

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