Effects of the implementation of acuity circle policy on waitlist and post-transplant outcomes of liver re-transplantation.

Abstract

Acuity circle (AC) policy implementation improved the waitlist outcomes for certain liver transplant (LT)-candidates. The impact of the policy implementation for liver retransplant (reLT) candidates is unknown. Using Organ Procurement and Transplantation Network/United Network for Organ Sharing (OPTN/UNOS) data from January, 2018 to September, 2021, we investigated the effect of the AC policy on waitlist and post-LT outcomes among patients who had previously received a LT. Patients were categorized by relisting date: Pre-AC (Era 1: January 1, 2018-February 3, 2020; n=750); and Post-AC (Era 2: February 4, 2020-June 30, 2021; n=556). Patient and donor characteristics, as well as on-waitlist and post-reLT outcomes were compared across eras. In Era 2, the probability of transplant within 90days overall and among patients relisted>14days from initial transplant (late relisting) were significantly higher compared to Era 1 (subdistribution hazard ratio [sHR] 1.40, 95% CI 1.18-1.64, p<.001; sHR 1.52, 95% CI 1.23-1.88, p=.001, respectively). However, there was no difference by era among patients relisted ≤14days from initial transplant (early relisting; sHR 1.21, 95% CI .93-1.57, p=.15). Likewise, among early relisting patients, risks for 180-day graft loss and mortality were significantly higher in Era 2 versus Era 1 (adjusted hazard ratio [aHR] 5.77, 95% CI 1.71-19.51, p=.004; and aHR 8.22, 95% CI 1.85-36.59, p=.005, respectively); for late relisting patients, risks for these outcomes were similar across eras. Our results show that the implementation of AC policy has improved transplant rates and reduced waiting time for reLT candidates listed>14days from initial transplant. However, the impact upon early relisting patients may be mixed.