*Purpose: In last decade, locoregional therapy (LRT) have been widely used to downstage HCC patients in order to qualify for liver transplantation. Large-scale direct comparisons of long-term post-transplant outcome for LRT and non-LRT recipients are lacking. We sought to investigate the association between LRT and post-transplant outcome in HCC liver transplant recipients using nationwide SRTR data.

*Methods: Using SRTR data January 2010-May 2021, we identified 17487 adult, first-time deceased donor liver transplant (DDLT) recipients who were granted HCC exception points. We compared all-cause graft failure (death or re-transplant) between LRT and non-LRT recipients using multivariate Cox regression in three separate groups: recipients with single tumor ≤3 cm, single tumor >3 cm and multiple tumors.

*Results: Among HCC recipients with single tumor ≤3 cm, ten-year graft failure rate for LRT and non-LRT recipients were 35.9% vs. 37.5%; after adjustment, LRT recipients had 10% lower graft failure rate compared to non-LRT recipients (aHR=_0.82 0.90 _0.99). Among HCC recipients with single tumor >3 cm, ten-year graft failure rate for LRT and non-LRT recipients were 44.9% vs. 40.3%; after adjustment, LRT recipients had 18% higher graft failure rate compared to non-LRT recipients (aHR= _1.00 1.18 _1.39). Among HCC recipients with multiple tumors, ten-year graft failure rate for LRT and non-LRT recipients were 39.2% vs. 37.4%; after adjustment, there was no evidence of association between the LRT and graft failure (aHR= _0.87 0.99 _1.14).

*Conclusions: Even after receiving LRT, HCC recipients with advanced tumor had similar or higher risk of graft failure compared to non-LRT recipients. LRT has better results in HCC recipients with small sized single tumor.

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