*Purpose: The purpose of this study was to determine any difference in resource utilization since the implementation of the mandatory six month wait-time policy for liver transplantation with hepatocellular carcinoma.

*Methods: We conducted a retrospective cohort study of adult liver transplants (LTX) from 2013- 2018. Patients were identified as Pre-Policy or Post-Policy based on 964 days before/after the wait-time policy. Differences across compared groups for continuous variables were assessed using the independent sample t-test and for binary variables using the chi-square test. All p-values were 2-sided and <0.05 was determined statistically significant.

*Results: Of the 369 adult liver transplants performed, 123 had HCC. We found statistical differences in recipient age (p=0.003), days on the waitlist (p=0.01), SVR (p<0.001), and HCC recurrence post LTX (p=0.04). There was no difference in recipient gender, BMI, or pre-transplant MELD. Resource utilization demonstrated significant differences in the number of treatment days pre-liver transplant (p=0.01) and the length of transplant admission stay (p=0.01). There was no difference between the pre/post wait-time groups for either graft survival or patient survival.

*Conclusions: There was lower HCC recurrence post 6 month wait-time but with greater resource utilization indicated by length of stay and number of treatment days pre-liver transplant without differences in graft or patient survival. Further studies are indicated to explore the potential benefits and costs associated with the wait-time policy.

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