non-LT centers, and high volume (>500 LT in 2009-2012) vs. lower volume (≤500 PLX4032 in vitro LT) LT centers. Data were reported as percentages, or mean±SD. Results: Patient and hospital-ization parameters in LT and non-LT centers are described in Table 1. LT centers had more extreme severity of illness, higher admission volumes, resource utilization and mortality. TDR, observed and O/E cost ratio were significantly higher for LT centers. High volume (5) compared
to lower volume (50) LT centers had a mean of 1076±223 vs. 894±315 admissions, p=0.1, frequency of specialized primary service 41±24% vs. 22±22%, p=0.06, O/E LOS ratio 1.17±0.16 vs. 1.04±.15, p=0.05, O/E cost ratio1.37±0.336 vs. 1.12±0.27, p=0.04, O/E mortality ratio 1.2±22 vs. 1±0.2, p=0.07, and TDR rate 26.4±2.9% FDA approved Drug Library solubility dmso vs. 25.7±4.4%,p=0.7, respectively. Conclusions: LT centers provide high volume, specialized care for patients with cirrhosis at higher costs and early readmissions. High volume LT centers are especially at risk for relatively worse outcomes without accurate risk adjustment for disease severity. Establishing benchmarks for quality metrics for LT centers need to take these observations into consideration. Disclosures: Marwan Ghabril – Grant/Research Support: Salix Paul Y. Kwo – Advisory Committees or Review Panels: Abbott, Novartis, Merck, Gilead,
BMS, Janssen; Consulting: Vertex; Grant/Research Support: Roche, Vertex, GlaxoSmithKline, Merck, BMS, Abbott, Idenix, Vital Therapeutics, Gilead, Vertex, Merck, Idenix; Speaking and Teaching:
Merck, Merck Naga P. Chalasani – Consulting: Salix, Abbvie, Lilly, Boerhinger-Ingelham, Aege-rion; Grant/Research Support: Intercept, Lilly, Gilead, Cumberland, Galectin The following people have SPTBN5 nothing to disclose: Samuel Hohmann, Eric S. Orman, Raj Vuppalanchi, A. Joseph Tector Introduction: There are limited data on geographic differences in access to liver transplantation (LT) in large cohorts of patients due to the inability to identify the population with end-stage liver disease (ESLD) in need of LT. Methods: We used 1999-2009 Medicaid data from CA, FL, NY, OH, and PA (40% of Medicaid population) to identify all patients 18-75 years of age with ESLD (cirrhosis + hepatic decompensation and/or hepatocellular carcinoma (HCC) using validated ICD-9 algorithms). Medicaid data were linked with UNOS transplant data. Results: Among 186,269 Medicaid enrollees with cirrhosis, 102,752 (55.2%) had ESLD, and 92,706 (90.2%) did not have a malignancy precluding LT. The initial indication for listing was decompensated cirrhosis in 83,483 (89.9%) patients and HCC in 9345 (9.1%). Only 7,738 (8.4%) ESLD patients were listed (77.3% with decompensated cirrhosis, 22.8% with HCC), with significant between-state variability: 5.5% and 5.6% in FL and OH, versus 8.6%, 9.6%, and 9.9% in NY, PA, and CA, respectively (P<0.001).