A 6‐Month Report on the Impact of the Organ Procurement and Transplantation Network/United Network for Organ Sharing Acuity Circles Policy Change

Chyou, Darius; Karp, Seth J.; Shah, Malay B.; Lynch, Raymond; Goldberg, David S.

doi:10.1002/lt.25972

Cited by 40 publications

(53 citation statements)

References 2 publications

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“…In February 2020, Organ Procurement and Transplantation Network/UNOS implemented the “acuity circle” policy, which prioritizes allocating liver organs to the sickest candidates within a 150‐250 nautical mile range from a donor service area. ( 11 ) In a secondary analysis, we compared median time from listing to transplant for all, patients with ALD, and patients without ALD in high MELD recipients between eras.…”

Section: Methodsmentioning

confidence: 99%

Impact of COVID‐19 Pandemic on Liver Transplantation and Alcohol‐Associated Liver Disease in the USA

et al. 2021

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Background & Aims:The surge in unhealthy alcohol use during the COVID-19 pandemic may have detrimental effects on the rising burden of alcohol-associated liver disease (ALD) on liver transplantation (LT) in the US. We evaluated the impact of the pandemic on temporal trends for LT including ALD. Approach & Results: Utilizing data from United Network for Organ Sharing, we analyzed waitlist outcomes in the US through March 1, 2021. In a short-period analysis, patients listed or transplanted between June 1, 2019 and February 29, 2020 were defined as the "pre-COVID" era and after April 1, 2020 were defined as the "COVID" era. Interrupted time-series analyses utilizing monthly count data from 2016-2020 were constructed to evaluate rate change for listing and LT prior to and during the COVID-19 pandemic. Rates for listings (P=0.19) and LT (P=0.14) were unchanged during the pandemic despite a significant reduction in the monthly listing rates for HCV (-21.69%, P <0.001) and NASH (-13.18%; P <0.001). There was a significant increase in ALD listing (+7.26%; P <0.001) and LT (10.67%; P <0.001) during the pandemic. In the COVID era, ALD (40.1%) accounted for more listings than those due to HCV (12.4%) and NASH (23.4%) combined. The greatest increase in ALD occurred in young adults (+33%) and patients with severe alcoholic hepatitis (+50%). ALD patients presented with a higher acuity of illness, with 30.8% of listings and 44.8% of LT having a MELD-Na > 30. Conclusions: Since the start of COVID-19 pandemic, ALD has become the most common indication for listing and the fastest increasing cause for LT. Collective efforts are urgently needed to stem the rising tide of ALD on healthcare resources.

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Section: Methodsmentioning

confidence: 99%

Impact of COVID‐19 Pandemic on Liver Transplantation and Alcohol‐Associated Liver Disease in the USA

et al. 2021

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“…However, the effect of these OPTN/UNOS organ allocation policies remains uncertain. Several studies analyzing the change in allocation policy demonstrate a reduction in transplant activity and the development of new geographic disparities, 11,13 along with increased organ travel time F I G U R E 4 HCC National and Regional Transplant Percentages by Native (Biologic) and Exception MELD, National and Regional Median Exception MELD, National and Regional Median Native MELD resulting in reduced graft quality. 14 We observed that one group of recipients, patients with HCC, were negatively affected by the policy.…”

Section: Discussionmentioning

confidence: 99%

“…Data for the 6-month period after the OPTN/UNOS allocation change went into effect demonstrates that overall liver transplant volume decreased by 2.7% compared to a 23.4% decrease in transplant volume for recipients with MELD exception points. 11 We assumed the MELD exception points created a reality where patients with identical diagnoses were assigned different MELD exception scores based on the geographic location of the patient's transplant center rather than the patient's specific disease, and this effect became more prominent following the implementation of acuity circles policy.…”

Section: Introductionmentioning

confidence: 99%

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Changing opportunities for liver transplant for patients with hepatocellular carcinoma

Zendel

Watkins

Moon

et al. 2022

Clinical Transplantation

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Introduction Aim was to study the early impact of acuity circle‐based allocation implementation system on liver transplantation for hepatocellular carcinoma (HCC) patients. Methods We assessed characteristics of HCC and non‐HCC deceased donor orthotopic liver transplants (OLT) in the year before (2/2019–2/2020) and after (3/2020–2/2021) introduction of the acuity circle policy using the Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) database. Results Total OLTs reduced from 6699 in the preacuity circle era to 6660 in the postacuity circle era (−.6%); this decrease is mostly driven by a decrease in HCC transplants (1529 to 1351; −11.6%). Six out of 11 regions had a reduction in the absolute number and percentage of HCC transplants with significant reductions in regions 2 (−37.8%, p < .001) and 4 (−28.3%, p = .001). Discussion The introduction of median model for end‐stage liver disease (MELD) at transplant minus 3 (MMaT‐3) exception points, has created differential opportunities for HCC patients, in low‐MELD as opposed to high‐MELD areas, despite having the same disease. This effect has become more prominent following the implementation of acuity circle‐based allocation system. Ongoing investigation of these trends is needed to ensure that HCC patients are not disparately disadvantaged due to their location.

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“…With the new United Network for Organ Sharing (UNOS) allocation policy based on acuity circles, it is thought that there will be a reduction in the geographic variation in MELD scores at the time of transplant. Although data thus far are scarce and possibly impacted by the COVID-19 pandemic, (15) preliminary Organ Procurement and Transplantation Network (OPTN) data suggest that the new policy has led to increased access for patients with high MELD scores and decreased access in patients with low MELD scores, therefore necessitating an increased use of donation after circulatory death (DCD) organs. (16) Prior work has demonstrated superior outcomes for LDLT in patients with low MELD scores compared with DCD transplant.…”

Section: The Past and Present States Of Ldltmentioning

confidence: 99%

Can Living Donor Liver Transplantation in the United States Reach Its Potential?

et al. 2021

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Living donor liver transplantation (LDLT) is a vital tool to address the growing organ shortage in the United States caused by increasing numbers of patients diagnosed with end-stage liver disease. LDLT still only makes up a very small proportion of all liver transplantations performed each year, but there are many innovations taking place in the field that may increase its acceptance among both transplant programs and patients. These innovations include ways to improve access to LDLT, such as through nondirected donation, paired exchange, transplant chains, transplant of ABO-incompatible donors, and transplants in patients with high Model for End-Stage Liver Disease scores. Surgical innovations, such as laparoscopic donor hepatectomy, robotic hepatectomy, and portal flow modulation, are also increasingly being implemented. Policy changes, including decreasing the financial burden associated with LDLT, may make it a more feasible option for a wider range of patients. Lastly, center-level behavior, such as ensuring surgical expertise and providing culturally competent education, will help toward LDLT expansion. Although it is challenging to know which of these innovations will take hold, we are already seeing LDLT numbers improve within the past 2 years.

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A 6‐Month Report on the Impact of the Organ Procurement and Transplantation Network/United Network for Organ Sharing Acuity Circles Policy Change

Cited by 40 publications

References 2 publications

Impact of COVID‐19 Pandemic on Liver Transplantation and Alcohol‐Associated Liver Disease in the USA

Impact of COVID‐19 Pandemic on Liver Transplantation and Alcohol‐Associated Liver Disease in the USA

Changing opportunities for liver transplant for patients with hepatocellular carcinoma

Can Living Donor Liver Transplantation in the United States Reach Its Potential?

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