*Purpose: With advances in surgical techniques, medical management, and more equitable allocation systems, children who receive a liver transplant today can expect remarkable outcomes early after liver transplantation. However, beyond 1-year post-transplant, attrition rates have not improved.

*Methods: We interrogated two separate eras (era 1: 01/1995 – 06/2004 vs. era 2: 7/2004 – 3/2018) of the Society of Pediatric Liver Transplant (SPLIT) registry to explore the evolution and associated factors contributing to late graft loss and late mortality.

*Results: The fraction of long-term pediatric liver transplant recipients surviving after 1-year with their first graft significantly improved (85.7% vs 81.5%, p<0.0001, Figure 1). This improvement occurred despite significant changes in patient selection toward higher risk populations (p<0.001), and without notable improvement in peri-operative complications such as hepatic artery thrombosis (p=0.24) and early post-transplant re-operation (p=0.94) that have historically contributed to poor late-allograft outcomes. Improved outcomes were associated with changes in patient characteristics and peri-operative practices, which subsequently impacted both early post-liver transplant complications as well as other sequalae known to contribute to adverse events in long-term pediatric liver transplant recipients.

*Conclusions: In conclusion, despite significant changes in patient selection toward higher risk populations, and without notable improvement in several peri-operative complications known to contribute to poor late-allograft outcomes, significant improvements in late graft loss and a trend toward improvement in late mortality was seen in a more recent cohort of children receiving liver transplant.

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