*Purpose: Hepatocellular carcinoma (HCC) is the most common primary malignant hepatic tumor. Currently, liver transplantation may be the optimal treatment for HCC. Patient selection criteria was dramatically changed when UNOS adopted the Median MELD at Transplant (MMaT) policy on September 29, 2019. This decreased the maximum exception MELD in our transplant region. The effect on patients transplanted for HCC is not yet clear.

*Methods: Retrospective review was conducted for patients transplanted with HCC between January 1, 2018 and November 1, 2021. Patient demographics, laboratory values, and outcomes were compared before and after the adoption of this policy.

*Results: One-year transplant survival was 90.3 vs 85.8% (p=0.065) between the 2 groups. 75 patients were transplanted in the 21 months prior to MMaT policy and 62 after adoption (p=0.03). The waiting time to transplant was 12.1 months in both groups. The median MELD was different in the two groups with patients’ having a biologic meld of 13 before MMat and 21 after adoption (p=0.02). The MELD at transplant was also different with the pre-MMat group being 32 and the post-MMaT group of 26 (p<0.001). There was a significant difference in the number of patients transplanted for HCC with 86.7% transplanted before MMaT vs 27.4% after (p<0.001). The number of patients with exception at transplant were distinct with 78.7% prior and 59.7% post-MMaT (p=0.02) The patients transplanted after the policy change had decreased functional status with lower Karnofksy scores (p=0.01).

*Conclusions: There has a been a significant decline in the number of patients getting transplanted for HCC since implementation of the MMaT policy with sicker patients with higher MELD scores being transplanted. The short-term survival of patients transplanted at our center has not changed but the long-term consequences of this policy remain unclear and the long-term impact needs careful attention.

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