Background
Transition from pediatric to adult transplant care is a high-risk period for liver transplant recipients, with increased vulnerability to rejection, infection, and lapses in adherence. Prior to 2019, transition education at our center was informal and variable. A standardized pediatric-to-adult transition education program was implemented to improve post-transition outcomes.

Methods
As a quality improvement pilot, outcomes were evaluated before and after implementation of a structured transition education program using American Society of Transplantation educational materials, initiated in November 2019. Patients transitioning to adult care who received transition education (TE) were compared with a historical cohort who did not receive structured education (NTE). Outcomes included biopsy-proven rejection, infection, death, graft loss, and BMI following transition. Fisher’s exact test and Wilcoxon rank sum tests were used for group comparisons.

Results
Forty-two pediatric liver transplant recipients were included (NTE n=28; TE n=14). Rejection occurred in 8 NTE patients (24.6%) compared to 1 TE patient (7.1%). Infections were more frequent in the NTE group (29%) than the TE group (14%). No differences were observed in death, graft loss, or BMI. Although differences did not reach statistical significance, outcome trends favored patients receiving transition education, with consistent pediatric and adult provider feedback supporting improved readiness and reliability of transition processes.

Conclusions
Implementation of a standardized pediatric-to-adult transition education program was associated with favorable trends in rejection and infection rates. These findings support transition education as a feasible quality improvement intervention with potential for standardized, scalable, and sustainable implementation across pediatric liver transplant programs.