Background: Trends in bridging locoregional therapies (LRT) and wait times for patients with hepatocellular carcinoma (HCC) undergoing orthotopic liver transplantation (OLT) have not been investigated in large-scale population studies.

Methods: Patients with HCC listed for OLT from 2002­2013 and transplanted up to 2014 were identified on the United Network for Organ Sharing (UNOS) database. Patients within Milan Criteria with approved HCC MELD exception were included. HCC OLT patients receiving LRT and their wait times were stratified by Transplant Year/UNOS Region. Regional differences were assessed via chi­-square tests and ANOVA.

Results: Of 14511 patients with HCC who received OLT, 3889 received bridging LRT, including 2926 who received TACE, and 1118 who received RFA. An increase in patients undergoing OLT for HCC from 2002-2013 was observed. The proportion of patients undergoing bridging LRT increased over time, from 19.8% in 2003 to 34.6% in 2013. Similarly, the proportion of patients undergoing bridging TACE increased overall, from 16.9% in 2003 to 38.2% in 2013. Significant differences in rate of bridging LRT use between regions was observed, ranging from 7.8% in Region 5 to 52.5% in Region 11 in 2013 (overall p<0.0001). A longitudinal increase in mean wait times to OLT was also observed (mean 275.5 days in 2002 to 423.6 days in 2014), with significant differences in wait times between regions (range 142.0 to 476.2 days in 2013, overall p<0.0001).

Conc: In HCC patients undergoing OLT, an overall and region-specific increase in both bridging LRT and overall wait times was observed from 2002-2013. Significant regional differences in rate of LRT use and wait times were demonstrated.

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