*Purpose: This study is designed to analyze factors related to long-term allograft fibrosis in clinically stable pediatric liver transplantation patients.

*Methods: Pediatric patients who underwent liver transplantation at Samsung Medical Center from January 1997 to January 2008 were reviewed. Ten-year protocol biopsies were reviewed by expert pathologist specialized in liver transplantation. The degree of inflammation and fibrosis were classified based on Banff criteria and METAVIR system, respectively. Analysis of risk factors related to allograft fibrosis was performed using multivariable logistic regression.

*Results: Sixty-six clinically silent pediatric patients who underwent 10-year post-transplantation biopsy were included. Protocol biopsy revealed 9 cases (13.6%) with rejection activity index≥3 based on Banff classification and 31 cases (47.0%) with METAVIR fibrosis stage ≥F1. All the characteristics were similar except for previous experience of rejection when classified by Banff criteria (29.4% in normal, 60.9% in indeterminant, and 55.6% in mild rejection, P=0.039) and METAVIR fibrosis (34.3% in F0, 36.8% in F1, and 83.3% in F2, P=0.009) More than 3 events with aminotransferases elevated above 50 U/L was the only significant factor for METAVIR F1-F2. (OR=3.351, CI=1.160-9.643, P=0.026) Mean total bilirubin≥1.0 mg/dL during the entire period (OR=10.388, CI=1.414-76.322, P=0.021) and experience of rejection (OR=10.403, CI=1.788-60.531, P=0.009) were significant risk factors for METAVIR F2.

*Conclusions: Even in clinically silent pediatric liver transplantation patients, long-term fibrosis occurs frequently and repeated elevation of aminotransferases were related to METAVIR F1-F2 while experience of rejection and elevated mean total bilirubin ≥1.0 mg/dL were related to METAVIR F2.

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