In October 2015, OPTN implemented a new policy for liver allocation, under which hepatocellular carcinoma (HCC) patients receive exception points only after a 6-month delay. This delay may lead to undetected HCC disease progression and recurrence after transplantation that may result in poor post-transplant outcomes. We sought to investigate the association between this policy change with all-cause graft failure (death or re-transplant) in HCC liver transplant recipients.

Methods: We identified 1907 adult, first-time deceased donor liver transplant (DDLT) recipients who were granted HCC exception points with SRTR data (2014-2016). We estimated cumulative incidence of all-cause graft failure using Kaplan-Meier curves, pre-2015 (10/8/2014-10/7/2015) and post-2015 (10/8/2015-10/7/2016). We compared 1-year graft failure using Cox regression, pre-2015 and post-2015, adjusting for recipient age, sex, race, and donor risk index (DRI).

Results: Allocation-MELD and lab-MELD at transplantation were both higher post-2015 than pre-2015 (allocation-MELD, median (IQR) 28 (23.5-28) vs. 22 (22-28), p=<0.01; lab-MELD, median (IQR) 12 (9-17) vs 11 (8-15), p<0.001) [Table 1].The one-year graft failure rate for HCC DDLT recipients was 7.5% pre-2015 and 8.1% post-2015 (log-rank test p =0.5) [Figure 1]. After adjustment, there was no evidence of association between the policy change and graft failure (aHR= _0.54 0.85 _1.35; p =0.5) [Figure-1].

Conclusions: There is no evidence that the 6-month policy delay has affected early post-DDLT outcomes for HCC patients. Long-term survival for HCC DDLT patients should be examined as the length of follow-up time after policy implementation increases.

CITATION INFORMATION: Ishaque T., Massie A., Haugen C., Segev D. Post-Transplant Outcomes under the New HCC Exception Policy Am J Transplant. 2017;17 (suppl 3).

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