Objective: Recombinant factor VIIa, an expensive coagulation factor, was previously utilized pre-operatively at UC San Diego Medical Center (UCSDMC) to reduce blood loss during Orthotopic Liver Transplant (OLT). Recent large randomized, controlled clinical trials have demonstrated a lack of efficacy and a potential risk of thromboembolic complications. As a result, use of recombinant factor VIIa for bleeding prophylaxis in OLT was discouraged due to compromised cost-effectiveness. This change in practice warranted validation through pharmacoeconomic outcomes research. Methods: A single-center, retrospective review was performed to determine if the change in UCSDMC OLT guidelines resulted in negative outcomes. The primary outcome measure was the volume of blood products required during OLT. Secondary outcomes included total cost of care, operating room time, LOS, and thromboembolic events. Results: 119 liver transplant recipients were included in the analysis. There was no significant difference in the primary outcome of blood product requirement. Patients receiving factor VIIa failed to demonstrate any statistically significant reduction in need for PRBC 13.8 vs 13.4 units (p=0.9), FFP 11.3 vs 15.6 (p=0.2), or PLT 4 vs 6.6 (p=0.08) when compared to controls. The secondary outcome measurements also failed to reach statistical significance, including LOS 23 vs 15 days (p=0.17), blood costs (p=0.92), surgical costs (p=0.69), and total cost of care (p=0.15). Two patients developed hepatic artery thrombosis in the treatment group compared to one patient in the control group. As measured by the Scientific Registry of Transplant Recipients (SRTR), no significant changes in liver transplant patient or graft survival were noted. An 83% reduction average recombinant factor VIIa use during OLT has been demonstrated, resulting in annual savings of $170K. Conclusion: Recombinant factor VIIa use for reduction of blood product requirements in OLT has not been demonstrated to be cost-effective and may be associated with a risk of thromboembolic events.