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. 2022 Mar;28(3):363-375.
doi: 10.1002/lt.26286. Epub 2021 Sep 25.

The Effect of Acuity Circles on Deceased Donor Transplant and Offer Rates Across Model for End-Stage Liver Disease Scores and Exception Statuses

Andrew Wey  1 , Samantha Noreen, Sommer Gentry, Matt Cafarella, James Trotter, Nicholas Salkowski, Dorry Segev, Ajay Israni, Bertram Kasiske, Ryutaro Hirose, Jon Snyder
Affiliations

The Effect of Acuity Circles on Deceased Donor Transplant and Offer Rates Across Model for End-Stage Liver Disease Scores and Exception Statuses

Andrew Wey et al. Liver Transpl. 2022 Mar.

Abstract

Acuity circles (AC), the new liver allocation system, was implemented on February 4, 2020. Difference-in-differences analyses estimated the effect of AC on adjusted deceased donor transplant and offer rates across Pediatric End-Stage Liver Disease (PELD) and Model for End-Stage Liver Disease (MELD) categories and types of exception statuses. The offer rates were the number of first offers, top 5 offers, and top 10 offers on the match run per person-year. Each analysis adjusted for candidate characteristics and only used active candidate time on the waiting list. The before-AC period was February 4, 2019, to February 3, 2020, and the after-AC period was February 4, 2020, to February 3, 2021. Candidates with PELD/MELD scores 29 to 32 and PELD/MELD scores 33 to 36 had higher transplant rates than candidates with PELD/MELD scores 15 to 28 after AC compared with before AC (transplant rate ratios: PELD/MELD scores 29-32, 2.34 3.324.71 ; PELD/MELD scores 33-36, 1.70 2.513.71 ). Candidates with PELD/MELD scores 29 or higher had higher offer rates than candidates with PELD/MELD scores 15 to 28, and candidates with PELD/MELD scores 29 to 32 had the largest difference (offer rate ratios [ORR]: first offers, 2.77 3.955.63 ; top 5 offers, 3.90 4.394.95 ; top 10 offers, 4.85 5.305.80 ). Candidates with exceptions had lower offer rates than candidates without exceptions for offers in the top 5 (ORR: hepatocellular carcinoma [HCC], 0.68 0.770.88 ; non-HCC, 0.73 0.810.89 ) and top 10 (ORR: HCC, 0.59 0.650.71 ; non-HCC, 0.69 0.750.81 ). Recipients with PELD/MELD scores 15 to 28 and an HCC exception received a larger proportion of donation after circulatory death (DCD) donors after AC than before AC, although the differences in the liver donor risk index were comparatively small. Thus, candidates with PELD/MELD scores 29 to 34 and no exceptions had better access to transplant after AC, and donor quality did not notably change beyond the proportion of DCD donors.

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Comment in

  • The Sky Is Not Falling.
    Fung JJ. Fung JJ. Liver Transpl. 2022 Mar;28(3):353-354. doi: 10.1002/lt.26382. Epub 2021 Dec 16. Liver Transpl. 2022. PMID: 34860456 No abstract available.

References

    1. Massie AB, Chow EKH, Wickliffe CE, Luo X, Gentry SE, Mulligan DC, Segev Dl. Early changes in liver distribution following implementation of share 35. Am J Transplant 2015;15:659–667.
    1. Austin PC, Stryhn H, Leckie G, Merlo J. Measures of clustering and heterogeneity in multilevel Poisson regression analyses of rates/count data. Stat Med 2018;37:572–589.
    1. Leppke S, Leighton T, Zaun D, Chen S‐C, Skeans M, Israni AK, et al. Scientific Registry of Transplant Recipients: collecting, analyzing, and reporting data on transplantation in the United States. Transplant Rev 2013;27:50–56.
    1. Feng S, Goodrich NP, Bragg‐Gresham JL, Dykstra DM, Punch JD, DebRoy MA, et al. Characteristics associated with liver graft failure: the concept of a donor risk index. Am J Transplant 2006;6:783–790.
    1. Wasserstein RL, Lazar NA. The ASA statement on p‐values: context, process, and purpose. Am Stat 2016;70:129–133.

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