Hepatocellular carcinoma (HCC) patients listed in short wait regions remain advantaged for liver transplant (LT) following 2015 HCC policy change

For patients with hepatocellular carcinoma (HCC) listed for liver transplant (LT), United Network of Organ Sharing (UNOS) enacted policy changes in 2015 to improve equity between HCC and non-HCC patients. We evaluated the impact of these changes on regional disparities in wait-list dropout and LT. We included patients in the UNOS database listed with MELD HCC exception in long (LWR), mid (MWR), and short wait regions (SWR) before these policy changes (Era 1: 1/1/2013-12/31/2013) and after (Era 2: 10/7/2015-10/7/2016). Cumulative incidence of wait-list dropout and LT were evaluated using competing risk regression. Median time to LT increased by 3.6 months (3.1 to 6.7) in SWR and 1.3 months (6.9 to 8.2) in MWR (p<0.001), with slight decrease in LWR (13.4 to 12.9 months; p=0.02). The 2-year cumulative incidence of dropout increased from 9.7% to 14.8% in SWR (p=0.03) and from 18.9% to 22.6% in MWR (p=0.18), but decreased from 26.7% to 24.8% in LWR (p=0.31). Factors predicting wait-list dropout included listing in Era 2 (HR 1.17), in LWR (HR 2.56), and in MWR (HR 1.91). Regional differences in wait-list outcomes decreased with policy changes, but HCC patients in SWR remain advantaged. Recent policy change may narrow these disparities.