title: The race to liver transplantation: a comparison of patients with and without hepatocellular carcinoma from listing to post-transplantation.
abstract: 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.
  
  
  METHODS
  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.
authors: Department of Surgery, Massachusetts General Hospital, Boston, MA.
authors: Madhukar S
authors: MS
authors: Patel
authors: Department of Pulmonary and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors: Rachel
authors: R
authors: Kohn
authors: Department of Surgery, University of California San Francisco, San Francisco, CA.
authors: Johannes R
authors: JR
authors: Kratz
authors: Department of Surgery, Massachusetts General Hospital, Boston, MA.
authors: Jigesh A
authors: JA
authors: Shah
authors: Department of Surgery, Massachusetts General Hospital, Boston, MA.
authors: James F
authors: JF
authors: Markmann
authors: Department of Surgery, Massachusetts General Hospital, Boston, MA. Electronic address: pvagefi@mgh.harvard.edu.
authors: Parsia A
authors: PA
authors: Vagefi
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000401:mortality / Q000601:surgery*; D058625:End Stage Liver Disease / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States; D014850:Waiting Lists