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The Effect of Acuity Circles on Deceased Donor Transplant and Offer Rates Across Model for End-Stage Liver Disease Scores and Exception Statuses
- Source :
- Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation SocietyReferences. 28(3)
- Publication Year :
- 2021
-
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.
- Subjects :
- medicine.medical_specialty
Carcinoma, Hepatocellular
Tissue and Organ Procurement
Waiting Lists
medicine.medical_treatment
Liver transplantation
Severity of Illness Index
End Stage Liver Disease
Liver disease
Model for End-Stage Liver Disease
Risk index
Internal medicine
medicine
Humans
Child
Transplantation
Deceased donor
Hepatology
business.industry
Liver Neoplasms
medicine.disease
Circulatory death
Liver Transplantation
Waiting list
Liver donors
Surgery
business
Subjects
Details
- ISSN :
- 15276473
- Volume :
- 28
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation SocietyReferences
- Accession number :
- edsair.doi.dedup.....3559cc24a3d7d02ddd2c126cb4ca7a4e