*Purpose: The aim of this study is to identify risk factors available at the time of initial DonorNet offer to predict discard of pediatric liver allografts.

*Methods: We used the United Network of Organ Sharing (UNOS) database to retrospectively analyze 16,668 deceased donors (<= 18-years-old) through univariate and multivariate logistic regressions. Risk factors found to be significant in the univariate analysis were entered into the multivariate analysis, and within the multivariate, risk factors with a p < 0.05 were identified as independent risk factors for liver allograft discard.

*Results: We analyzed 17 potential risk factors for increased risk of allograft discard and identified 11 of these factors as significant predictors (p <0.05) of pediatric liver allograft discard. The most significant risk factors were: donation after circulatory death (odds ratio [OR], 18.38; confidence interval [CI], 16.00-21.12), total bilirubin > 10 mg/dL (OR, 11.84; CI, 5.50-25.51), and alanine transaminase (ALT) >= 500 IU/L (OR, 5.36; 95% CI, 4.04-7.10). Table 1 contains the multivariate analysis.

*Conclusions: Our comprehensive multivariate analysis identified elevated chemistry and liver function tests (ALT, AST, total bilirubin, serum sodium levels, creatinine levels, hepatitis B core ab), donor demographics (BMI, height, age), and donor characteristics (CDC high-risk, donation after circulatory death) as risk factors associated with pediatric liver discard. This data could be used as a framework to produce an index to predict pediatric allograft discard which can then optimize allocation of marginal allografts.

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