Background: Pediatric liver transplantation has become the standard treatment for children suffering from end-stage liver disease. To overcome the shortage of appropriate-sized whole liver for children, technical variant liver transplantation has developed for decades. However, the impact of graft types on the outcomes is less clear.

Methods: We perform a meta-analysis to compare the transplant outcomes between pediatric whole liver transplantation and technical variant liver transplantation. The primary outcomes of the current meta-analysis were patient and graft survival rates, and the secondary outcomes were the incidence of surgical complications.

Results: The 1-year, 3-year, 5-year patient survival rate and 1-year, 3-year graft survival rate were significantly higher in whole liver transplantation than technical variant liver transplantation group (OR = 1.62, 1.90, 1.65, 1.78, and 1.62, respectively, all p < 0.05). There was no significant difference in 5-year graft survival rate between the two groups (OR = 1.47, p = 0.10).

The incidence of portal vein thrombosis and biliary complications were significantly lower in whole liver transplantation group (OR = 0.45 and 0.42, both p < 0.05). The incidence of hepatic artery thrombosis was not statistically different between the two groups (OR = 1.21, p = 0.61).

Conclusion: Pediatric whole liver transplantation is with better outcomes than technical variant liver transplantation. Continuing efforts should be made to minimize surgical complications to improve the outcomes of technical variant liver transplantation.

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