Introduction: Liver transplantation (LT) is a critical therapeutic option for pediatric chronic liver diseases; however, waitlist mortality remains a major challenge. In Mexico, the Instituto Nacional de Pediatria program began in 2019, navigating barriers such as donor shortages and prolonged protocolization. This study describes survival from protocol initiation to transplantation or death and identifies associated clinical factors.

Methods: A retrospective cohort of 77 patients (under 18 years) evaluated for LT between July 2018 and May 2025 was analyzed. Diagnoses were categorized into Biliary Atresia (BA) and other chronic liver diseases (including Caroli syndrome, Alagille syndrome, hepatoblastoma, metabolic, or autoimmune diseases). Survival was evaluated using the Kaplan-Meier method with the Log-Rank (Mantel-Cox) test.

Results: Forty-one patients (53.2%) had BA, while 36 (46.8%) presented other chronic liver diseases. A significant difference in mortality was found between groups (Log-Rank p < 0.001). For the BA group, the median survival was 17 months (95% CI: 9.4 – 24.5). In contrast, the group with other chronic hepatopathies did not reach median survival (91.7% survival rate), with an estimated mean survival of 62.5 months (95% CI: 48.4 – 76.6). 

Conclusion: Biliary Atresia carries a significantly worse survival prognosis than other chronic liver diseases. The lack of overlap between confidence intervals (BA: 9.4–24.5 vs. Others: >48.4 months) confirms that mortality risk in BA patients is earlier and higher, highlighting the urgent need for timely diagnosis and early intervention in Mexico.