*Purpose: The aim of this study is to evaluate the outcomes following liver transplantation (LT) in adults using grafts from a pediatric deceased donor.

*Methods: A retrospective, single-center study identifying adult LT using pediatric (≤12 years) deceased donor liver grafts (PD group) was conducted from 2013-2020. A 1:2 case-control match was performed to identify adults receiving a graft from an adult donor ≥18 years (AD group) in the same period based on recipient age (±10 years), model for end-stage liver disease (MELD) score at transplant (±5 points) and indication for LT. Patient data was obtained through electronic medical records chart review. Early complication rates were identified and graded using Dindo-Clavien classification. Graft and patient survival were assessed by Kaplan-Meier curves.

*Results: 479 patients were identified. From those, 12 patients received a graft from a deceased pediatric donor and were matched with 24 adults receiving a graft from an adult donor. Recipient mean age, body mass index (BMI), and MELD were similar between groups. Male gender was significantly higher in the AD group compared with the PD group (20 (83.3%) vs 4 (33.3%), p=0.003). Alcohol related cirrhosis was the most common indication for transplant in both groups, followed by hepatocellular carcinoma, seen in 50% and 33.3% of recipients in each group, respectively. As expected, donor mean (SD) age and donor BMI were significantly higher in the AD group (47.13 (± 15.87) vs 8.83 (± 2.72), p=0.001 and 28.70 (± 6.16) vs 17.0 (± 2.67), p=0.032, respectively). Cold ischemia time and warm ischemia time were similar between groups. There was no recipient mortality in the PD group, while one (4.2%) recipient in the AD group died two months after LT. According to Dindo-Clavien classification, no significant difference was found among groups. Three (25%) patients developed minor complications in the PD group, versus 7 (29.1%) in the AD group. Major complications (≥3b) were seen in 4 patients in both groups (33.3% vs 16.7%, respectively). The most common complication was bile duct stricture in both groups, seen in 3 (25%) and 4 (16.7%) recipients in the PD group and AD group, respectively (p=0.55). Hepatic artery thrombosis was seen in 2 patients (16.7%) within the first week, successfully managed by thrombectomy and hepatic artery reconstruction without the need of re-transplantation in the PD group and in one (4.2%) in the AD group, (p=0.2). Graft and patient survival at 1-, 3-, and 5- year were similar among groups for all time periods (100% vs 96%, p=0.48).

*Conclusions: We observed an excellent patient and graft survival in liver transplantation with pediatric deceased donor livers into adult recipients. Careful donor recipient matching and close monitoring for potential biliary and vascular complications is crucial to achieve acceptable outcomes.

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