metabolic syndrome and encephalopathy. Markers of physical frailty, LFI and DASI, predict LTwaiting list mortality. THU245 Early versus late hepatocellular carcinoma (HCC) recurrence after liver transplantation for HCC: patterns and long-term outcome Nada Eldomiaty 1,2,3,4 , Faouzi Saliba 1,2,3 , Vincent Karam 1 , Rodolphe Sobesky 1,2,3 , Eric Vibert 1,2,3 , Audrey Coilly 1,2,3 , Eleonora De Martin 1,2,3 , Gabriella Pittau 1,2,3,5,6 , Oriana Ciacio 1,2,3,5,6 , Antonio Sa Cunha 1,2,3 , Khaled Amer 7 , Maysaa Saeed 4 , Daniel Cherqui 1,2,3,8 , René Adam 1,5,6 , Didier Samuel 1,2,3,8 . 1 AP-HP, Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France; 2 Univ Paris-Sud, UMR-S 1193, Université Paris-Saclay, Villejuif, France; 3 Inserm, Unité 1193, Université Paris-Saclay, Villejuif, France; 4 Faculty of Medicine, Zagazig University, Tropical Medicine Department, Zagazig, Egypt; 5 Univ Paris-Sud, UMR-S 935, Université Paris-Saclay, Villejuif, France; 6 Inserm, Unité 935, Université Paris-Saclay, Villejuif, France; 7 International Medical Center, Hepato-Biliary and Liver Transplant Department, Cairo, Egypt; 8 Hepatinov, Villejuif, France Email: faouzi.saliba@aphp.fr Background: Hepatocellular carcinoma (HCC) is the most common indication of liver transplantation (LT). HCC recurrence is the main complication affecting short and medium term outcome after liver transplantation (LT). The aim of this study is to analyze the patterns and outcome of patients who developed HCC recurrence according to post-transplant time of recurrence. Method: Consecutive patients who underwent LT for HCC between 2000 and 2017 at our center were recruited. Characteristics of patients, recurrence, modalities of treatment and outcome were collected retrospectively. Patients were divided according to time of recurrence: early (≤2 years post-transplant) and late (>2 years post- transplant). Results: 433 patients (mean age: 57.8 ± 8.5 years; 83.8% were males) underwent LT for HCC. Mean follow-up was 74.6 ± 58.6 months. Seventy-five patients (17%) developed HCC recurrencewith a mean time to recurrence of 29.7 ± 31.8 months. Patient who developed recurrence had as expected more tumors outside Milan and UCSF criteria, a significantly high AFP score and microvascular invasion at pathology. Recurrence site at diagnosis was intrahepatic only (16.0%), extrahepatic only(61.3%) and intrahepatic and extrahepatic (22.7%). 71.2% of the recurrent HCC cases were treated by systemic chemotherapy. The mean AFP level at the time of diagnosis of early HCC recurrence 1061 ± 3545 ng/mL and 292 ± 805 ng/mL in the late HCC recurrence group. Early recurrence developed in 46 patients (61.3%) and late recurrence occurred in 29 patients (38.7%). The median survival times from the diagnosis of the HCC recurrence were similar 15 months and 17 months respectively in the earlyand late recurrence groups (p = 0.12). The 5,10 and 15-year patient survival of the whole cohort were respectively 74.6%, 59.0% and 48.6%. The overall 5, 10 and 15-year recurrence free survival rate was 70.6%, 55.4% and 46.3%. Among the patients who developed an early HCC recurrence the overall 5, 10 and 15-year survival rates were similar 6.7% and significantly shorter than those patients with late recurrence respectively at 5,10 and 15 years, 64.0%, 27.1% and 0% (log rank p < 0.0001). Conclusion: In this large cohort with long-term follow-up, late HCC recurrence has been associated with a good long-term survival. Early HCC recurrence is associated with very bad prognosis, in relation to more aggressive tumor and either tumor progression or bad selection criteria at time of transplant. THU246 Epidemiology, features and outcome of patients transplanted for hepatocellular carcinoma in the last decade: a single-center experience Federica Invernizzi 1 , Massimo Iavarone 1 , Daniele Dondossola 2 , Barbara Antonelli 2 , Arianna Zefilippo 2 , Tullia De Feo 3 , Marco Maggioni 4 , Angelo Sangiovanni 1 , Pietro Lampertico 1 , Giorgio Rossi 2 , Maria Francesca Donato 1 . 1 Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, CRC “A. M. and A. Migliavacca” Certer for Liver Disease, Division of Gastroenterology and Hepatology, Milan, Italy; 2 Fondazione IRCCS Cà Granda Ospedale Maggiore Hospital, University of Milan, HBP Surgery and Liver Transplantation Unit, Milan, Italy; 3 Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, North Italy Transplant Program, Coordinamento Trapianti, Milan, Italy; 4 Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Nuclear Medicine Department, Milan, Italy Email: federica.invernizzi@policlinico.mi.it Background and Aims: Hepatocellular carcinoma (HCC) represents an increasing indication for liver transplantation (LT) world-wide but the burden and clinical implications of post-transplant HCC recur- rence is still debated. Aim of this study was to identify recurrence rate, survival and predictors of recurrence in HCC patients consecutively transplanted in the last 10-years. Method: retrospective, single center study including all consecutive LT patients with HCC from 01/2010 to 07/2019. HCC-recurrence surveillance was performed with CT-scan and AFP every 6 months for the first 5-yrs after LT. Immunosuppressionwas CNI-based. Results: 182 HCC out of 449 transplanted patients (41%) were studied: 84% males, median age 58-yrs, 60% HCV, 25% MELD ≥ 15, median AFP at LT 9 ng/ml; median time-lag between HCC diagnosis and LT was 17 months, pre-LT bridging/down-staging therapy in 74%. At explant pathology: 16% showed micro-satellitosis, 27% micro- vascular invasion (mVI), 50% Edmonson score = G3/4; 76% were “Milan”-in, 11% were “Milan”-in and “Up to 7”-in while 13% “Up to 7”- out. During a median follow-up of 42 months, HCC recurred in 29 patients (16%) after a median time of 9 (2–46) months. Probability of recurrence at 1-, 3-, 5-yrs was 5%, 11% and 15%, respectively. By multivariate analysis, independent risk-factors for HCC recurrence were micro-satellitosis (HR = 0.31, p = 0.023) and microvascular invasion (HR = 0.38, p = 0.04). Overall probability of survival at 1-, 3- and 5-yrs was 94%, 87% and 77%, respectively; being 95%, 89% and 85% in the recurrence-free patients vs 89%, 76% and 43% in the recurrence-group (p < 0.005). Those patients who were transplanted after 2015 (n = 108), significantly differed from those transplanted before 2015 (n = 74), since they were older (p = 0.04), more frequently males (p = 0.02), with lower MELD (p = 0.0001) at transplant, more frequently treated by locoregional therapies for bridging/down- staging purposes ( p = 0.002) and with higher rates of G3/4-HCC ( p = 0.001) at explant pathology, however with similar post-transplant overall survival [100.9 (95%CI 90.16–111.8) vs 91.4 81.7–101.1) months ( p = 0,15)]. Conclusion: Our study confirms tumor-related features at explant pathology as predictors of HCC recurrence. Moreover, in the last few years we have transplanted older patients with less severe disease but with more advanced tumors, while maintaining survival figures well fitted with a transplant benefit. POSTER PRESENTATIONS S261 Journal of Hepatology 2020 vol. 73 | S123–S400