EARLY IMPACT OF ACUITY CIRCLE ALLOCATION POLICY ON DISCARDED LIVERS; ANALYSIS OF UNOS REGISTRY
Recommended Citation
Shamaa TM, Miyake K, Ivanics T, Mohamed A, Kitajima T, Collins K, Rizzari M, Yoshida A, Abouljoud MS, Nagai S. EARLY IMPACT OF ACUITY CIRCLE ALLOCATION POLICY ON DISCARDED LIVERS; ANALYSIS OF UNOS REGISTRY. Hepatology 2022; 76:S60-S61.
Document Type
Conference Proceeding
Publication Date
10-1-2022
Publication Title
Hepatology
Abstract
Background: The disparity between the number of individuals on the wait list and available liver allografts creates the need for a system that maximizes donor liver utilization. Liver allocation in the United States was updated on February 4th, 2020, by introducing the acuity circle (AC)-based model. This study aims to determine the early impact of AC-based model on the rates and characteristics of discarded livers. Methods: Using the United Network for Organ Sharing (UNOS) registry, 119,286 adult deceased donors available between January 1st, 2010, and December 28th, 2021. Three periods were defined according to the organ retrieval date: MELD era (Jan 1st, 2010, to Jan 9th, 2016; 2435 days; n=50,370), MELD-Na era (Jan 11th, 2016, to Feb 2nd, 2020; 1483 days; n= 43,738) and post-AC era (Feb 4th, 2021, to Dec 30th, 2021; 695 days; n= 25,178). Discarded allografts were defined as deceased donor liver allografts that were recovered with the intent to be transplanted but discarded. Percentages of discarded allografts were analyzed using Pearson's Chi-Squared test for independence. Continuous variables were reported as a median (Interquartile range) and compared using the Mann-Whitney test. Results: The number of deceased donor liver offers per day increased during post-AC era compared to previous allocation policies (36.2 offers/day vs. MELD-Na: 29.5 offers/day vs. MELD: 20.7 offers/ day; p<0.001) [Figure 1]. This eventually was reflected on increased daily liver transplantation (LT) during the post-AC era (23.0 Tx/day vs. MELD-Na: 21.0 Tx/day vs. MELD: 15.1 Tx/day; p<0.001). Compared to previous allocation policies, the number of deceased donor livers not recovered (23.9 livers/day vs. MELD-Na: 15.8 livers/day vs. MELD: 13.6 livers/day; p<0.001) and the discarded deceased donor livers increased during post-AC era (2.4 livers/day vs. MELD-Na: 2.1 livers/day vs. MELD: 1.7 livers/day; p<0.001). When looking at the characteristics of discarded deceased donor livers during the post-AC era, deceased donors had higher median BMI (30.8 vs. MELD-Na: 30.1 vs. MELD: 29.8; p<0.001), less likely to be Extended Criteria Donor (30.2% vs. MELD-Na: 32.3% vs. MELD: 35.1%; p<0.001) or DCD (62.0% vs. MELD-Na: 69.8% vs. MELD: 80.5%; p<0.001) and more likely to be DBD (38.0% vs. MELD-Na: 30.2% vs. MELD: 19.5%; p<0.001) compared to previous allocation policies. Conclusion: While AC-based liver allocation increased the number of overall LT per day, there has been a modest increase in the number of discarded deceased donor livers and a significant increase in the number of deceased donor livers not recovered possibly due to logistical reasons related to surgeons' preferences and travel arrangement. Transplant centers and surgeons should be aware of these changes in order to maximize utilization of potential deceased donor livers to minimize the LT candidates' time on waitlist. (Figure Presented).
Volume
76
First Page
S60
Last Page
S61
