ObjectivesPerioperative coagulation management in liver transplantation recipients is challenging. Viscoelastic testing with rotational thromboelastography (TEG) can help quantify hemostatic profiles. We aimed to investigate whether the etiology of end stage liver disease, pre-transplant disease severity, or pre-transplant thrombotic or bleeding complications are associated with specific TEG patterns. DesignRetrospective cohort study. SettingSingle quaternary care hospital. Participants1,078 adult liver transplant patients. InterventionsThe primary exposure was the etiology of end stage liver disease classified as either intrinsic or non-intrinsic (e.g., biliary obstruction, or cardiovascular). Secondary exposures were patients’ preoperative MELD score, Child-Pugh class, presence of major preoperative thrombotic complications and major bleeding complications. Measurements and Main ResultsPatients with intrinsic liver disease (84%) showed higher odds of hypocoagulable (OR: 3.70, 95% CI: 1.94-7.07, P<0.0001) and mixed TEG patterns (OR: 4.59, 95% CI: 2.07-10.16, P=0.0002) compared to those with non-intrinsic disease. Increasing MELD correlated with higher odds of hypocoagulable (OR: 1.14, 95% CI: 1.08-1.19, P<0.0001) and mixed TEG patterns (OR: 1.08, 95% CI: 1.03-1.14, P = 0.0036). Child-Pugh class C had higher odds of hypocoagulable (OR: 8.55, 95% CI: 3.26-22.42, P<0.0001) and mixed patterns (OR: 12.48, 95% CI: 3.89-40.03, P<0.0001). Major preoperative thrombotic complications were not associated with specific TEG patterns – although we observed an interaction with liver disease severity. ConclusionsLiver transplantation candidates with intrinsic liver disease tend to exhibit hypocoagulable TEG patterns, while non-intrinsic disease is associated with hypercoagulability. Increasing end stage liver disease severity as evidenced by increasing MELD and higher Child Pugh classification, was also associated with hypocoagulable TEG patterns.