Waitlist time predicts survival after liver transplantation for hepatocellular carcinoma: a cohort study in the United Network for Organ Sharing registry

Hepatocellular carcinoma (HCC) is the third most common malignancy worldwide and often occurs in cirrhotic patients in the U.S. Liver transplantation (LT) offers the unique advantage of curing both HCC and underlying liver disease. The Milan Criteria—adopted by UNOS—define LT eligibility based on tumor size and number, yielding 5-year survival rates exceeding 70%. However, HCC progression during wait times leads to significant dropout despite low MELD scores. To address this, UNOS implemented MELD exception points for HCC patients in 2002, prioritizing LT based on tumor progression risk. This system aims to balance organ allocation fairness with optimal outcomes.