We thank Akbulut et al for their letter to the editor (1) on our study (2) which analyzed patients with hepatocellular carcinoma (HCC) in the UNOS database with at least one measured AFP >1000 ng/ml prior to liver transplant (LT). We validated recently approved national policy (3) by demonstrating significantly improved post-LT outcome among patients with a reduction in AFP to <500 ng/ml with local-regional therapy (LRT). Akbulut et al raised the concern that >70% of patients included in this study did not fulfill this national policy and also pointed out that over one-third of included patients did not receive LRT prior to LT. We absolutely agree that patients with AFP >1000 ng/ml should not undergo LT but instead first undergo LRT with a goal of achieving AFP reduction. We would like to clarify that the study period of 2005-2015 predated OPTN/UNOS HCC policies mandating AFP reduction to <500 ng/ml prior to LT if ever >1000 ng/ml as well as a waiting period of 6 months before granting MELD exception. Prior to this latter policy, some HCC patients were offered LT within a few months after listing (4) and thus often did not receive LRT prior to LT. Since institution of the 6 month wait policy, nearly all listed HCC patients now receive at least one LRT prior to LT (5).