*Purpose: To evaluate the effect of policy changes in liver graft allocation for hepatocellular carcinoma (HCC) on the overall survival of patients of different ethnicities in the United States.

*Methods: De-identified patient-level data from the United Network for Organ Sharing (UNOS) for all adults undergoing a first-time cadaveric LT for HCC between March 2002 and June 2017 were analyzed. Exclusion criteria were LT for other primary or secondary malignancies, recipients of multivisceral or partial grafts, donation after cardiac death, redo transplants, and LT performed across ABO incompatible blood groups. Comparisons were performed among the cohorts of patients transplanted between March 2002 and December 2006 (Era 1), January 2007 and October 2015 (Era 2), November 2015 and June 2017 (Era 3). Survival analysis was performed using Kaplan Meier limited to 24 months and recipient ethnicity was used as strata.

*Results: The study population was represented by 13,856 recipients with a mean age of 58 and 25% were female. Caucasians represented 65% of the population, Hispanics 14%, African Americans 10%, Asians 9% and others 1%. The mean size of the largest tumor was 2.5 cm and was not significantly different by race. We found no significant demographic, clinical or oncological differences among ethnic groups. In the combined cohort, African Americans had lower overall survival than other ethnicities (pairwise analysis, all Sidak p-values<0.05). Among all racial groups, African Americans had the greatest improvements in survival during Era 2 and Era 3 compared to Era 1 (Table 1). The survival differences between African Americans and other ethnicities decreased over time and during Era 3 there were no differences among ethnicities (Figure 1).

*Conclusions: The overall survival of patients undergoing first-time cadaveric LT for HCC has improved. Among all ethnic groups, African Americans had the lowest survival in Era 1 and 2 but their survival gap resolved during the most recent years (Era 3).

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