INTRODUCTION: Delirium is a common issue following liver transplantation (LT), but research has mainly focused on single-center cohorts. METHODS: We studied delirium in a national cohort of adult LT recipients transplanted October, 2015-December, 2020 using the MarketScan database. Claims data were used to identify LT recipients with delirium. Characteristics and outcomes of LT recipients with and without delirium were compared using descriptive statistics. RESULTS: Among 2051 LT recipients, only 32 (1.6%) had a delirium claim. Recipients with versus without delirium were more likely to have a history of encephalopathy (21.9% versus 8.2%, P = 0.006) but were of similar age and sex. Recipients with versus without delirium were more likely to be discharged to skilled care or rehabilitation facilities (37.5% versus 14.3%, P = 0.003) and had longer median hospital stays (24 versus 14 ds, P = 0.03). Delirium claims were not associated with median hospitalization costs (P = 0.15) or 30-d (P = 0.32) and 60-d (P = 0.99) readmission. CONCLUSIONS: Overall, only 1.6% of adult LT recipients had delirium claims, despite prevalence estimates of up to 47% in single-center studies. This underreporting-which is likely limited to the most severe cases-limits our ability to assess associated outcomes and highlights the need for better delirium recognition and reporting.