Current allocation policy is favorable for patients with hepatocellular carcinoma waiting for liver transplantation

Abstract Background Patients with hepatocellular carcinoma (HCC) are a growing population of the transplantation waiting list (WL) for orthotopic liver transplantation (OLT). There is no consensus to prioritize these patients while on the WL. Aims To assess whether patients with HCC were more prioritized than non-HCC patients based on their WL survival as primary outcome. Methods Restrospective cohort study including patients listed for elective OLT from January 2013 to January 2016. Results 165 patients with cirrhosis were listed for OLT: 64 in the HCC group (38.78%) and 101 in the non-HCC group (61.22%). Outcomes (HCC vs. non-HCC) were: OLT in 75.51% vs. 64.37%; death or dropout due to worsening in 20.41% vs. 27.59%, and delisting because of improvement in 4.08% vs. 8.05%. HCC patients had a significantly higher WL survival rate (HR = 0.45; 95% CI: 0.21–0.96); lower MELD score at transplantation (21 [20–24] vs. 24 [20–30]; p = 0.021); higher delta-MELD – the difference between MELD at transplantation and MELD at listing time – (3 [2–6] vs. 0 [0–5]; p = 0.024) and longer waiting time until OLT (143 [70–233] vs. 67 [21–164] days; p = 0.008). Conclusion Despite having to wait longer, patients with HCC showed higher WL survival than non-HCC patients.