Wu WK, Ziogas IA, Matsuoka LK, et al. - Findings show significantly higher waitlist mortality for pediatric liver transplantation (LT) candidates with hepatocellular carcinoma (HCC) vs for hepatoblastoma (HBL), while similar posttransplant patient and graft survival were revealed. This underscores an opportunity to enhance equitable prioritization for children with HCC who could have decreased access to size-appropriate deceased donor organs and less effective bridge-to-transplant therapies.

• The United Network for Organ Sharing registry (February 2002 to September 2020) was used to retrospectively assess the waitlist and posttransplant results of pediatric LT candidates with HBL and HCC.

• This study involved 668 children with HBL and 95 children with HCC listed for first LT.

• An elevated risk of waitlist mortality was seen in HCC cases in univariable (unadjusted subdistribution hazard ratio [sHR] = 4.37) and multivariable competing risk regression (adjusted sHR = 3.08) accounting for age and laboratory Model for End-stage Liver Disease/Pediatric End-stage Liver Disease score.

• A total of 595 children had LT for HBL and 76 for HCC.

• Patient (adjusted hazard ratio [HR] = 0.77) or graft survival (adjusted HR = 0.74) did not differ between HCC and HBL recipients.