[HCC TRANSPLANT CANDIDATES' SURVIVAL ON THE WAITING LIST - CAN ORGAN UTILIZATION BE IMPROVED?].

Introduction: Patients with hepatocellular carcinoma (HCC) receive Model for End-Stage Liver Disease (MELD) prioritization points. These aim to prevent waiting list drop-out due to tumor progression. This practice has resulted in an imbalance in the access of HCC vs. non-HCC patients to liver transplantation (LT). Recently this practice has been questioned and the policy in Israel changed, reducing the priority to "low risk" HCC patients.

Aims: To analyze the survival on the waiting list of HCC patients and the influence of the change in our policy.

Methods: This is a retrospective study analyzing the National Transplant Center data for HCC patients who were listed for LT from January 2009 to December 2018. Statistical analyses were performed to identify independent predictors of outcome. Outcomes of HCC patients were compared to non-HCC controls separately before (period A) and after implementation of changes in the allocation policy (period B).

Results: The study population consisted of 1188 patients listed for LT , 231 due to HCC .The transplant rates were 179/231 (80%) for the HCC group and 390/957 (40%) for cirrhotic patients and the drop-out rates 10.8% vs 31% respectively. During period B the transplantation rate for cirrhosis increased to 44% for cirrhotic and remained 77% for HCC. The outcome of "low risk" HCC with no priority on the waiting list, did not change significantly.

Conclusions: HCC patients had higher chances to get transplanted and better survival compared to non-HCC patients. With the new policy the transplantation rate for non-HCC increased without deteriorating the HCC patient's outcome. HCC patients still have better survival on the list than non-HCC liver transplant candidates. Further analysis is needed to adjust HCC candidates' prioritization and improve organ allocation in Israel.