Introduction: Palliative care (PC) consults for end-stage liver disease patients are underutilized. Reasons cited include misconceptions about PC and poor reimbursement. However, early consults have shown to improve symptom management and lower costs. University Hospital (UH) is a transplant center providing advanced liver care. Our study looks at UH’s use of PC consults compared to other centers, and of aggressive therapies and code status changes in patients with versus without PC consultation. Methods: 100 patients were randomly selected from a “liver pre-transplant” list between 01/01/2021 – 01/01/2022. We collected: sex, age, undergoing orthoptic liver transplant (OLT) evaluation, listed or transplanted, admission related to liver disease and code status. We looked at the most recent/relevant admission for any ICU care, whether palliative care consults were placed outside or in ICU and any code status changes. For patients with an ICU stay, we recorded data on intubation, pressors and continuous veno-venous hemodialysis (CVVHD) use. Results: Of the 100 patients, 26 were under OLT evaluation: 11 were listed, 15 were not. Of the 74 patients not under evaluation, 39 were transplanted and 35 not listed. Of the OLT listed patients, 6 (54.55%) were admitted. None required ICU and 1 (16.67%) had a PC consult and a code status change. Of those not evaluated/listed/transplanted, 12 patients (34.29%) were admitted; 2 (16.67%) required ICU and 3 (25%) had PC consulted with 1 done in the ICU with a code status change. Out of all the admissions that required ICU level of care, 17 (80.95%) underwent intubation, 5 (23.81%) required pressors, and 6 (28.57%) underwent CVVHD. Of those with ICU stays and PC consults, 3 (75%) required pressors and CVVHD and all were intubated. Conclusions: 25% of admitted non-OLT-listed patients and 16.67% of OLT listed patients had PC consults. Other studies reported 34.4% of non-transplanted and 11% of de-listed/non-transplant patients were referred to PC. Overall, UH demonstrates a similar utilization of PC consultation as other liver centers. Use of aggressive therapies did not appear to be influenced by PC. Study limitations include a small sample size only from a single admission. Future studies should examine how including PC in pre-OLT evaluations would affect patient outcomes.