*Purpose: Rural candidates may be disadvantaged on the liver waiting list. We evaluated rates and hazards of waitlist dropout and transplant by urbanicity.

*Methods: We selected active adult deceased donor liver candidate statuses from the SRTR standard analysis files July 1, 2013-Jun 30, 2016. Dropout (waitlist mortality or removal due to becoming too sick) and transplant rates were calculated by MELD group and urbanicity. Cox proportional hazard (PH) models estimated the effect of urbanicity by MELD group. We adjusted for potential confounders (age, BMI, sex, blood type, race, Latino ethnicity, private vs. public insurance).

*Results: Overall, dropout rates were lower for metropolitan than for non-metropolitan candidates (0.202 vs. 0.217 dropouts per person-year), as were transplant rates (0.443 vs. 0.472) (Table 1). In univariable Cox PH models, these differences were significant (p=0.0192, dropout; 0.0055 transplant). Accounting for allocation MELD group, dropout and transplant rates were still lower for metropolitan candidates (Table 2). In Cox PH models, these differences were significant, even after adjusting for potential confounders (p=0.0103, dropout; 0.0002, transplant). Results were similar when adjusting for laboratory MELD instead of allocation MELD.

*Conclusions: Non-metropolitan adult liver candidates saw higher rates and hazards for both waitlist dropout and transplant, even after accounting for MELD, age, BMI, sex, blood type, race, Latino ethnicity, and insurance type. Although significant, the absolute differences in dropout and transplants rate were small, on the scale of 1 to 3 events per 100 person-years.

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