OBJECTIVES:  Major bleeding in orthotopic liver transplantation (OLT) is associated with significant morbidity and mortality. Limited data exists regarding comparative effectiveness of four-factor prothrombin complex concentrate (4PCC) and fibrinogen concentrate (FC) in OLT. This study evaluated the effectiveness of 4PCC and FC on intraoperative blood product utilization during OLT. METHODS:  A retrospective, observational, single-institution propensity score matched cohort was conducted involving OLTs utilizing 4PCC and/or FC intraoperatively from December 2013 to April 2016. Patients were included if they were greater than 18 years of age and undergoing OLT. Patients were excluded if they received simultaneous heart or lung transplantation, or did not have a documented anesthesia operative note. Greedy propensity score match technique was used to match patients unexposed to exposed patients in a 2 to 1 ratio. The authors hypothesized that intraoperative use of 4PCC with or without FC during OLT would decrease the intraoperative packed red blood cell (pRBC) unit requirements by 2 units compared to patients who did not receive drug exposure. RESULTS:  During the study timeframe, 212 patients received OLT with 39 4PCC exposures. The matched study population included 39 patients exposed to 4PCC with or without FC, and 78 patients not exposed to 4PCC. After propensity score matching, no factors included in the model were significantly different or had standardized mean differences greater than or equal to 0.11. No statistical difference was found in pRBC or fresh frozen plasma (FFP) utilization in the exposure group compared to the unexposed group (mean pRBC unit: 12.4 ± 8.0 units versus 9.7 ± 5.6 units, p-value=0.058; mean FFP unit: 10.0 units ± 6.3 versus 12.7 ± 9.7 units, p-value=0.119, respectively). CONCLUSIONS:  Intraoperative use of 4PCC with or without FC did not reduce intraoperative blood product requirements at a single institution.