*Purpose: Transplant programs differ in relative volume of kidney and liver transplants. While there is a known volume-outcome relationship for organ-specific transplantation at an institutional level, it is unknown if the volume-outcome relationship for one type of solid organ transplantation transfers improved outcomes to another type of solid organ transplantation. Whether relative abdominal organ transplant center volume is related to patient and graft survival has important implications for the design of national quality standards.

*Methods: The Scientific Registry of Transplant Recipients was queried for all isolated kidney and liver transplants performed between 2005 and 2014 with follow-up through June 2019. Centers were categorized based on relative volume: kidney dominant (high kidney and low liver volumes, n = 24), balanced (relatively even volumes, n = 99), liver dominant (low kidney and high liver volumes, n = 25), or kidney-only (n = 116) centers. Multivariate Cox models, adjusted for donor quality, recipient factors, year of transplant, and organ-specific center volumes, estimated the differences in death-censored graft loss and patient mortality by relative category.

*Results: Compared to balanced transplant centers, the risk of kidney graft loss was higher at kidney dominant (HR 1.11, P < 0.001), kidney only (HR 1.07, P < 0.001), and liver dominant (HR 1.09, P < 0.001) centers. Kidney recipient mortality was worse at kidney only centers (HR 1.07, P < 0.001), with non-significant differences at the other two center types. Risk of liver graft loss was higher in kidney dominant centers (HR 1.18, P = 0.002), while liver recipient mortality was lower at liver dominant (HR 0.95, P = 0.03) centers.

*Conclusions: A relatively higher volume of liver transplants, leading to a more balanced transplant center, appears to be beneficial for both kidney and liver graft and patient outcomes. This may be due to improved local resource availability and expertise. Given that this effect is relatively consistent across different sizes of centers, consideration should be given to shared resources that affect all organs within a transplant center to optimize patient and graft outcomes.

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