*Purpose: On October 8, 2015, a revised liver policy regarding HCC exception scores was implemented with the intention to create a better balance in transplant opportunities between candidates with HCC exceptions and those with allocation priority based on their calculated MELD/PELD score. The mandated waiting period of 6 months before receiving HCC exceptions points may also lead to lower HCC recurrence rates by identifying more aggressive HCC biology during the observation period. The effect of this policy on HCC recurrence and posttransplant survival was investigated.

*Methods: A retrospective analysis of 86 HCC patients who underwent liver transplantation at our institution between Jan. 1, 2010 and July 1, 2017 was conducted. Two groups of patients were compared – those listed for transplant prior to Oct. 8, 2015 (n=73), and those listed after (n=13). Donor and recipient characteristics were compared between the two groups. Time between transplant and detected recurrence was determined. Posttransplant survival was also compared using Kaplan Meir curves with Log rank test. Pearson Chi-square tests were used to compare dichotomous variables and two-sided t-test was used to compare continuous data.

*Results: No significant differences in recipient characteristics including age, sex, or MELD score at listing were found between pre-policy and post-policy revision groups. Within a year posttransplant, 5 out of 73 (6.9%) recurred in the pre-policy group while 1 out of 13 (7.7%) recurred in the post-policy group (p=0.91). All 5 patients who died from metastatic recurrent HCC were in the pre-policy change group. MELD score at listing did not differ between the two groups. MELD score at time of transplant trended higher in post-policy revision group (mean=26, SD=5.65) than in pre-policy revision group (mean=22, SD=7.3), but was not statistically significant (p=0.064). There was no difference in 2-year posttranplant survival between the 2 groups (89.0% before policy revision and 92.3% after, p=0.52).

*Conclusions: Our preliminary study suggests that the revised policy has resulted in no change in HCC recurrence 1-year post-transplantation, but suggests the potential of some benefit in HCC-related mortality with the policy revision. With the revised liver policy, a higher MELD score was required at time of transplant for post-policy recipients. The relative increase in MELD at time of transplant in the post-policy group is consistent with the policy assigning 28 exception points after a 6-month waiting period instead of the previous 22 exception points initially. This policy has led to some potential MELD inflation at our center.

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