In October 2015, OPTN implemented a revised liver allocation policy to address the disparity between HCC and non-HCC patients in access to deceased-donor liver transplant (DDLT). Under the new policy, HCC patients obtain exception points only after 6 months on the waitlist. The impact of this policy change on access to DDLT for HCC and non-HCC patients has not been described.

Methods: Using SRTR data on 30,689 adult, first-time, active DDLT waitlist registrants 2007-2016, we compared access to DDLT and mortality risk in HCC vs. non-HCC patients, pre-implementation (10/8/2014-10/7/2015) and post-implementation (10/8/2015-5/31/2016). We used Cox regression to model cause-specific hazard, and Fine and Gray methods to model mortality accounting for the competing risk of transplantation, adjusting for age, gender, race, and initial biological MELD. Waitlist dropout due to deteriorating condition was classified as mortality.

Results: Pre-implementation, HCC patients had 3-fold higher access to DDLT than non-HCC patients (aHR= _2.84 3.07 _3.33) but also had an increased risk of death/dropout (aHR= _1.47 1.72 _2.01). After accounting for the reduction in mortality in both groups due to transplant, HCC and non-HCC patients had a comparable chance of experiencing waitlist death/dropout (asHR= _0.92 1.08 _1.26). Post-implementation, HCC patients still had greater access to DDLT, but the association was attenuated to a 2-fold difference (aHR= _1.76 1.96 _2.18). After accounting for the reduction in mortality in both groups due to transplant, HCC patients and non-HCC patients continued to have a comparable chance of waitlist death/dropout (asHR= _0.67 0.85 _1.07) [table 1].

Conclusion: The HCC allocation policy change reduced the disparity in access to DDLT between HCC and non-HCC patients with no increase in relative waitlist mortality for HCC patients.

CITATION INFORMATION: Ishaque T, Massie A, Bowring M, Ruck J, Cameron A, Philosophe B, Segev D. HCC and Liver Transplantation Following the Recent Allocation Policy Change. Am J Transplant. 2017;17 (suppl 3).

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