*Purpose: This study evaluated center performance for wait-list outcomes for adult candidates awaiting liver retransplantation (reLT), and its association with initial liver transplant (iLT) center performance.

*Methods: Using data from the Scientific Registry of Transplant Recipients, center-specific standardized rate ratios (observed / expected) adjusted for recipient and donor factors, and time between transplants were computed for three separate analyses: (i) graft failure (GF), measured from iLT (Figure – Panel A); (ii) reLT (Panel B) and (iii) death (Panel C), each measured from date of post-GF wait-listing. Separate Cox models were used for each analysis, with competing risks methods employed for (ii) and (iii).

*Results: Among 125 transplant centers, 84 (67.2%) had “as-expected” GF rates following iLT, with 19 (15.2%) and 22 (17.6%) centers having better-than- and worse-than-expected outcomes, respectively. There was considerably more heterogeneity in reLT rate (Panel B) and re-waitlist mortality (Panel C) performance than in center iLT GF rates (Panel A). Sixteen of 110 (14.6%) centers performed better-than-expected in terms of reLT rates, while 9 (8.2%) were worse-than-expected. Regarding re-waitlist mortality, there were more than twice as many under-performing centers (20.2%, 19/94) and fewer high-performing centers (10.6%, 10/94). There was no significant correlation between center-specific reLT and reWL performance (r=0.16, p=0.1).

*Conclusions: Center performance for reLT-related outcomes is far more heterogeneous than for iLT. Further research is needed to better understand the factors driving the wide disparity observed in reLT waitlist mortality across centers.

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