*Purpose: Studies have suggested that shorter waiting times (WT) for liver transplant (LT) in patients with hepatocellular carcinoma (HCC) may be associated with increased HCC recurrence and decreased disease-free survival. MELD exception points are granted after patients have waited 6 months to address disparity in access for LT candidates without HCC. In this study, we aim to assess the outcome of LT (overall and disease free survival) in HCC patients who were transplanted without the proposed 6-month delay.

*Methods: Retrospective review was conducted on all patients who underwent LT for HCC at our institution from 2014 to 2019. Patients with incidentally diagnosed with HCC on explant, those with living donors, and second time transplant recipients were excluded. Data was collected on characteristics of recipients and donors, MELD at transplant, WT with HCC, locoregional therapies, and tumor characteristics. WT was determined by either time from listing to transplant or time from HCC diagnosis to transplant, whichever was shorter. Survival analyses were conducted using Cox regression models and Kaplan Meier curves.

*Results: 153 patients underwent LT during the study period: 102 had <6 months WT and 51 >6 months WT. Median WT was 1.9 months (IQR 0.9-3.6) vs 9.1 months (IQR 6.6-16.2) in the two groups. Patients with shorter WT had a significantly lower median MELD at transplant (22) than those who waited longer (28) (p<0.0001). However, those transplanted with shorter WT were not more likely to receive a DCD vs DBD donor (p=0.150). The 1 year disease free survival for those with shorter WT was 88.2% vs 96.1% for longer WT (p=0.143). The HCC recurrence rate was 7.8% in both WT groups (p=1.0). WT did not impact disease-free survival (Figure 1). Those with high risk HCC, however, had decreased disease-free survival (HR 3.33 (CI 1.36, 8.18)) (p=0.030) compared to patients with low risk HCC. Interestingly, AFP level, tumor stage at diagnosis and pathologic stage on explant were not associated with disease-free survival (p=0.359, p=0.329 and p=0.203).

*Conclusions: Shorter WT to transplant did not significantly impact disease-free survival in patients with HCC. Moreover, shorter WT did not influence whether the patient received a DBD or DCD donor. Using extended criteria donors, patients with HCC and favorable tumor response had similar disease free survival when compared to those transplanted with 6 month delay.

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