The race to liver transplantation: A comparison of patients with and without hepatocellular carcinoma from listing to post-transplantation

Background There are geographic and disease-specific inequities in liver allograft distribution. We examined differences between hepatocellular carcinoma (HCC) and non-HCC liver transplantation (LT) candidates from listing through LT in a region with prolonged wait times. Study Design We performed a single-center retrospective study, from 2005 to 2013, of adult, primary, nonstatus 1 candidates who were listed and subsequently underwent LT (n = 270), or were removed because of death or clinical deterioration (n = 277). Results Of the HCC candidates removed from the waitlist (n = 184), 5.5% died waiting, 25.5% deteriorated clinically, and 69% had LT. Of the non-HCC candidates (n = 363), 38.8% died waiting, 21.8% clinically deteriorated, and 39.4% had LT. Of the LT recipients, 127 (47%) had HCC. When compared with non-HCC transplant recipients, HCC recipients spent more time on the waitlist (435 ± 475 vs 301 ± 604 days, p = 0.045) and from listing until LT had higher total pre-transplant hospital admissions per patient (1.1 ± 1.2 vs 0.8 ± 1.8, p < 0.001). These admissions were more often planned (0.65 ± 0.88 vs 0.17 ± 0.52 planned admissions per patient, p < 0.001) and of shorter duration (2.7 ± 2.8 vs 5.2 ± 4.6 days, p < 0.001). The HCC and non-HCC recipients demonstrated similar overall post-transplant survival (5 year 80% vs. 83%, respectively; p = 0.84). Conclusions Despite a shorter wait to have LT, non-HCC candidates at our center have inferior waitlist outcomes. National reprioritization of liver allocation to improve access for non-HCC candidates may lead to increased wait time and resource use for the HCC population; however, a mortality benefit may exist for the non-HCC candidate lacking the benefit of time.