Introduction Prior studies suggest that there is a significant association between low center performance evaluations and reduced kidney transplant volume in the United States. However, it is unclear whether this effect is directly associated with public reporting of center outcomes and/or other processes associated with centers with declining outcomes or effects are more pronounced in recent years attributed to increased regulatory oversight. Methods We evaluated the association of SRTR performance evaluations of transplant centers and change in kidney transplant volume over two distinct four year periods (Period 1:2003-2006 and Period 2:2007-2010). Period 2 followed the issue of the Conditions of Participation by CMS. We measured the change in kidney transplant volume among US centers in each period using national SRTR data and evaluated differences in changes between the two periods. Results In Period 1, there was an average decline in volume among centers with low performance but this change was not statistically significant (p=0.53). In Period 2, there was a significant decline in average transplant volume among centers with low performance evaluations (p=0.003, Figure 1). Overall there was less growth in average transplant volume in Period 2 as compared to Period 1 (-17.6 transplants per SRTR reporting period). However this change was tempered among centers with no low performance evaluations(-12.2 transplants) and centers with a low performance flag in Period 1 but not in Period 2(-14.8 transplants). In contrast, centers with low performance evaluations in Period 2 but not Period 1 had more marked reduction in volume(-44.4 transplants) as well as centers with low performance evaluations in both periods(-43.5 transplants,p=0.029).Figure: No Caption available.Conclusions The effects of performance evaluations on transplant volume are dramatically more apparent in recent years. Further understanding of the mechanisms of these effects and development of policies to incentive transplant growth concurrent with quality oversight are critically important.