*Purpose: Studies have shown significant improvement in hepatocellular carcinoma (HCC) recurrence rates following the UNOS implementation of a six-month wait period. However, few have examined the HCC dropout rates for patients awaiting liver transplant surgery. Our objective was to evaluate the outcomes in HCC dropout rates before and after the mandatory six-month wait policy enacted on October 8, 2015.

*Methods: We conducted a retrospective cohort study of adult patients who were added to the liver transplant waitlist between January 1, 2012 and March 8, 2019. Pediatric patients (age <18 were excluded). Data was obtained from electronic medical records and OPTN publicly available national data.

*Results: We reviewed 767 patients of whom 193 were waitlisted with the diagnosis of HCC – 92 patients pre-policy and 101 patients post-policy. Our HCC dropout rate increased from 11.9% to 20.8% (p=0.03). Our HCC transplant rate decreased from 88.0% pre-policy to 62.4% post-policy (p<0.001). The national HCC dropout rate increased from 26.3% to 29.0%. The national HCC transplant rate decreased from 70.5% to 67.3%.

*Conclusions: Dropout rates for HCC patients increased locally and nationally since implementation of the mandatory 6-month wait period for HCC patients. The UNOS mandate is achieving the goal of increased organ allocation for non-HCC patients with fewer transplants for HCC patients. Further studies are indicated to analyze the financial burden associated with extended treatment for HCC patients and improved liver function vs. HCC progression in HCC dropout patients.

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