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2% (vs. 22.8% in 2001-2005 [ = 0.24]), and jaundice-free survival with native liver post-KPE was 24.0% (vs. 20.1% in 2001-2005 [ = 0.5]). Compared with the 2001-2005 analysis, all criteria showed improvement but the differences are statistically not significant. Our observation shows that KPE management requires improvement in Germany. Centralization of BA patients to German reference liver units is not yet mandatory. However, European and national efforts with regard to the centralization of rare diseases support our common endea