Purpose Pediatric centers vary widely in their tendency to implant ventricular assist devices (VAD) in children with dilated cardiomyopathy (DCM) awaiting heart transplant (HT). The magnitude of this variability is unknown. We sought to describe center variability in pediatric VAD utilization and to determine whether higher VAD utilization is associated with better waitlist outcomes. Methods and Materials All pediatric centers with at least 12 DCM patients listed for transplant since 2004 were identified using OPTN data. Centers were defined as high VAD utilization if the proportion of DCM patient with VAD was in the top tertile (>27% supported with VADs), low VAD utilization centers below the bottom tertile ( Results Of the 1,105 children in 38 centers; gender, age, and weight at time of listing were similar across low-, medium-, and high-VAD utilization centers. The percentage of patients supported on ECMO/ventilator at time of transplant did not differ between low-, medium-, and high-VAD utilization centers, (23%,19% and 24% respectively). Overall, 22% of children with DCM received VADs (range 0-53%). The percentage of patients who were transplanted or recovered at 6 months did not differ between low-, medium- and high VAD utilization centers (74%, 68% and 78% respectively, P=0.21). Compared to high VAD utilization centers, the risk of death or wait-list removal due to deterioration was not statistically different to low (HR 1.32, 95%CI 0.77-2.28) and medium VAD utilization centers (1.26 95% CI 0.73-2.17). Conclusions VAD utilization for children with DCM vaires markedly across centers despite little difference in patient characteristics at the time of listing. Waitlist outcomes appear similiar between centers with ligh and low VAD utlization, suggesting further studies are needed to clarify which patient are likely to benefit from VAD support.