*Purpose: Liver Re-transplantation is the only option for survival when a transplanted liver fails. However, Re-transplantion of the liver remains a challenge given the scarcity of donor organs and the fact that previous reports have shown inferior outcomes with retransplanted livers compared to primary transplants. Few prognostic models have been created in children that receive Re-transplants. In this study, we evaluate the outcomes of pediatric liver Re-transplantation and propose a prognostic scoring system to risk-stratify patients by clinical characteristics to guide decisions.

*Methods: We examined the SRTR database of children (*Results: Recipient age(p < 0.001; reference: >12 years; 0 – 6 months: aHR = 5.05; 6 months – 1 year: aHR = 1.39; 1 – 5 years: aHR = 1.63, 5-12 years: aHR = 0.94), Primary Diagnosis(p = 0.04; reference: biliary atresia; Acute Hepatic Necrosis: aHR = 1.87; Cholestatic Liver Diseases: aHR = 1.64; Non-cholestatic Cirrhosis: aHR = 1.98),Recipient on life support at time of retransplant(p < 0.001, aHR = 2.60), Survival time of the first graft(p = 0.006; reference: < 1 week; 7-30 days: aHR = 1.20; 1 month - 1 year: aHR = 1.43; 1-5 years: aHR = 2.56; >5 years: aHR = 2.27) , Graft type(p = 0.033; reference: whole liver; split liver: aHR = 1.50, partial liver: aHR = 0.75) , and donor age > 40(p = 0.008, aHR = 1.95) years were significant predictors of re-transplant survival. Table I shows the constructed prognostic score system. Survival was significantly different (p < 0.001) for those at low risk (0-4 points), medium risk (5-7 points), and high risk (8+ points) (Figure 1). Furthermore, survival was equivalent between low risk pediatric re-transplant recipients and pediatric primary liver transplant recipients (p = 0.46) but significantly worse for medium (p < 0.001) and high risk (p < 0.001) re-transplant recipients

*Conclusions: With simple clinical characteristics, this scoring tool can modestly discriminate between those children at high risk and those children at low risk of poor outcomes after liver Re- transplantation. If validated by future studies, this scoring system could provide prognostic guidance to the family and patient.

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