Objectives <p>This study aimed to analyze the pattern and risk factors for vascular complications (VC) in 2 pediatric LTx centers, one in Egypt and the other in the UK.</p> Patients and methods <p>A retrospective analysis on children undergoing LTx over the years (2015–2020) in group 1 (<i>n</i> = 46 patients; all of them underwent living donor LTx) and over the years (2014–2023) in group 2 (<i>n</i> = 300 patients: 92% were deceased donor LTx and only 8% were living donor LTx).</p> <p>Liver unit database was reviewed in different time periods post-transplant (first week, 4 weeks, 3 months, 6 months, 1 year, 5 years, and 10 years for VC, e.g., hepatic artery thrombosis (HAT) and stenosis (HAS), portal vein thrombosis (PVT) and stenosis (PVS), and hepatic vein thrombosis (HVT)).</p> Results <p>The overall prevalence of vascular complications was comparable between both groups, occurring in 21.7% of patients (10 out of 46 in group 1 and 65 out of 300 in group 2). These complications predominantly manifested during the early postoperative period (within the first month), affecting 13% of group 1 and 9.3% of group 2 patients. HAT emerged as the most frequent vascular complication in both cohorts, present in 3 patients (6.5% in group 1) and 20 patients (6.7% in group 2), followed by PVT (2 patients (4.3%) and 17 patients (5.6%), respectively) and hepatic vein complications (1 patient (2.17%) and 8 patients (2.6%), respectively). Notably, using multivariate logistic regression analysis, HAT showed a significant correlation with recipient weight &lt; 10 kg (<i>P</i> value 0.019), use of split grafts (<i>P</i> value 0.024), prolonged cold ischemia time (<i>P</i> value 0.035), and donor-recipient size mismatch (<i>P</i> value 0.039). Similarly, PVT was significantly associated with recipients under 10 kg (<i>P</i> value 0.004), pre-existing PV anomalies (<i>P</i> value 0.005), split liver grafts (<i>P</i> value 0.020), donor-recipient size mismatch (<i>P</i> value 0.015), and reduced intraoperative portal vein flow (<i>P</i> value 0.028). Biliary atresia was the most common diagnosis among patients with HAT and PVT, followed by metabolic liver disease in HAT.</p> Conclusion <p>Recipients &lt; 10 kg body weight, split graft recipients, and longer cold ischemic times had a higher incidence of vascular complications. A high index of suspicion needs to be maintained in the evaluation of the children with biliary atresia and metabolic liver disease peri-operatively and in long-term follow-up.</p> Trial registration <p>ClinicalTrials.gov, TRN: NCT04104971. Registration date: 01 October 2019.</p>