Background:
The Indian Liver Transplant Registry (ILTR) was initiated in 2018 by the Liver Transplant Society of India (LTSI) to collect comprehensive prospective data on liver transplantation, including early and late outcomes. This report represents the first analysis of pediatric liver transplantation (LT) in India.

Objective:
To present the outcomes of pediatric LT based on data from the ILTR.

Methods:
This multicenter, cross-sectional study analyzed children under 18 years who underwent liver transplantation and were enrolled in the ILTR between 2018 and 2024.

Results:
Pediatric LT data was provided by 22 liver transplant centres across India ( 90 days). A total of 1,100 children underwent liver transplantation during the study period. Males comprised 645 (58.4%) of the cohort, with a median age of 20 months (IQR: 10–84 months) and a median weight of 9 kg (IQR: 7–19 kg). Living donor liver transplantation (LDLT) was predominant, accounting for 1,081 cases (98.2%). Specific etiological diagnoses were available for 876 children (80%), with biliary atresia being the most common indication (504 cases, 45.8%), followed by progressive familial intrahepatic cholestasis (74 cases, 6.7%) and Wilson disease (49 cases, 4.4%). Metabolic liver diseases represented 24.2%, while liver tumors accounted for 2.5% of cases. Immediate postoperative complications included hepatic artery thrombosis (27 cases, 2.4%), portal vein thrombosis (44 cases, 4%), bile leaks (35 cases, 3.1%), and re-laparotomy (82 cases, 7.4%). Survival rates at 3 months and 1 year were 93.7% and 92.5%, respectively.

Conclusion:
This inaugural report from the Indian subcontinent highlights the demographic and etiological profiles of pediatric liver transplantation, revealing unique etiological variations compared to Western cohorts. While short-term outcomes are encouraging, the lack of long-term follow-up data underscores the need for enhanced data collection processes