*Purpose: Transplantation for selected patient with HCC has been prioritized with a MELD exception since 2002. Further changes have decreased the maximum exception for HCC. Most recently, UNOS adopted Acuity Circles (AC) to better allocate organs rather than using Donor Service Areas. The effect of these AC on HCC patients transplant rates especially at higher acuity centers like ours is unclear.

*Methods: Retrospective review for patients transplanted with HCC between January 1 2018 and November 1 2021 was completed. Patients were divided in to 2 groups pre- and post- implementation of AC on February 4, 2020. Patient demographics, laboratory values, and outcomes were compared.

*Results: 83 patients were transplanted pre-AC and only 54 post-AC (p<0.001). One-year survivals were not different between the two groups with pre-AC 91.2% vs 82.2% (p=0.3). Age, Race, and BMI were similar in both groups. The median meld at transplant was different with 30 pre- and 26 post-AC (p<0.001). The biologic meld rose with median pre-AC of 13 and post-AC of 23 (p=0.01). The percentage of patients with exception at transplant also decreased from 80.7% to 53.7% (p<0.001). There was a significant decrease in MELD-delta or the difference from biologic to exception meld from 18.5 pre-AC to 7 post-AC (p<0.01). The median wait list time was similar. The median distance traveled for the organ procurement was 166 nautical miles vs 40 (p=0.53).

*Conclusions: The adoption of AC has changed the number and type of HCC patients getting transplanted at our center. Less HCC patients were transplanted after implementation of AC. Though there was no significant change in the survival and distance travelled for organ procurement, there is a growing concern over HCC patients having to wait for transplants and hence newer strategies including consideration of living donor evaluation may need to be considered to improve HCC transplant rates.

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