{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T21:25:54Z","timestamp":1792099554516,"version":"4.4.0"},"reference-count":18,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2021,9,25]],"date-time":"2021-09-25T00:00:00Z","timestamp":1632528000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2021,9,25]],"date-time":"2021-09-25T00:00:00Z","timestamp":1632528000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Liver Transpl"],"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:p>Acuity circles (AC), the new liver allocation system, was implemented on February 4, 2020. Difference\u2010in\u2010differences analyses estimated the effect of AC on adjusted deceased donor transplant and offer rates across Pediatric End\u2010Stage Liver Disease (PELD) and Model for End\u2010Stage 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\u2010year. Each analysis adjusted for candidate characteristics and only used active candidate time on the waiting list. The before\u2010AC period was February 4, 2019, to February 3, 2020, and the after\u2010AC 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\u201032, <jats:sub>2.34<\/jats:sub>3.32<jats:sub>4.71<\/jats:sub>; PELD\/MELD scores 33\u201036, <jats:sub>1.70<\/jats:sub>2.51<jats:sub>3.71<\/jats:sub>). 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, <jats:sub>2.77<\/jats:sub>3.95<jats:sub>5.63<\/jats:sub>; top 5 offers, <jats:sub>3.90<\/jats:sub>4.39<jats:sub>4.95<\/jats:sub>; top 10 offers, <jats:sub>4.85<\/jats:sub>5.30<jats:sub>5.80<\/jats:sub>). Candidates with exceptions had lower offer rates than candidates without exceptions for offers in the top 5 (ORR: hepatocellular carcinoma [HCC], <jats:sub>0.68<\/jats:sub>0.77<jats:sub>0.88<\/jats:sub>; non\u2010HCC, <jats:sub>0.73<\/jats:sub>0.81<jats:sub>0.89<\/jats:sub>) and top 10 (ORR: HCC, <jats:sub>0.59<\/jats:sub>0.65<jats:sub>0.71<\/jats:sub>; non\u2010HCC, <jats:sub>0.69<\/jats:sub>0.75<jats:sub>0.81<\/jats:sub>). 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.<\/jats:p>","DOI":"10.1002\/lt.26286","type":"journal-article","created":{"date-parts":[[2021,9,5]],"date-time":"2021-09-05T14:56:40Z","timestamp":1630853800000},"page":"363-375","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":58,"title":["The Effect of Acuity Circles on Deceased Donor Transplant and Offer Rates Across Model for End\u2010Stage Liver Disease Scores and Exception Statuses"],"prefix":"10.1097","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2584-3018","authenticated-orcid":false,"given":"Andrew","family":"Wey","sequence":"first","affiliation":[{"name":"Scientific Registry of Transplant Recipients,Hennepin Healthcare Research Institute,Minneapolis,MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha","family":"Noreen","sequence":"additional","affiliation":[{"name":"Organ Procurement and Transplantation Network,United Network for Organ Sharing,Richmond,VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4530-8917","authenticated-orcid":false,"given":"Sommer","family":"Gentry","sequence":"additional","affiliation":[{"name":"Scientific Registry of Transplant Recipients,Hennepin Healthcare Research Institute,Minneapolis,MN"},{"name":"Department of Mathematics,United States Naval Academy,Annapolis,MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matt","family":"Cafarella","sequence":"additional","affiliation":[{"name":"Organ Procurement and Transplantation Network,United Network for Organ Sharing,Richmond,VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Trotter","sequence":"additional","affiliation":[{"name":"Division of Transplant Hepatology,Baylor University Medical Center,Dallas,TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Salkowski","sequence":"additional","affiliation":[{"name":"Scientific Registry of Transplant Recipients,Hennepin Healthcare Research Institute,Minneapolis,MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorry L.","family":"Segev","sequence":"additional","affiliation":[{"name":"Scientific Registry of Transplant Recipients,Hennepin Healthcare Research Institute,Minneapolis,MN"},{"name":"Department of Surgery,Johns Hopkins University,Baltimore,MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajay","family":"Israni","sequence":"additional","affiliation":[{"name":"Scientific Registry of Transplant Recipients,Hennepin Healthcare Research Institute,Minneapolis,MN"},{"name":"Department of Epidemiology and Community Health,University of Minnesota,Minneapolis,MN"},{"name":"Department of Medicine,Hennepin Healthcare,Minneapolis,MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4809-6956","authenticated-orcid":false,"given":"Bertram","family":"Kasiske","sequence":"additional","affiliation":[{"name":"Scientific Registry of Transplant Recipients,Hennepin Healthcare Research Institute,Minneapolis,MN"},{"name":"Department of Medicine,Hennepin Healthcare,Minneapolis,MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryutaro","family":"Hirose","sequence":"additional","affiliation":[{"name":"Scientific Registry of Transplant Recipients,Hennepin Healthcare Research Institute,Minneapolis,MN"},{"name":"Department of Surgery,University of California, San Francisco,San Francisco,CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon","family":"Snyder","sequence":"additional","affiliation":[{"name":"Scientific Registry of Transplant Recipients,Hennepin Healthcare Research Institute,Minneapolis,MN"},{"name":"Department of Epidemiology and Community Health,University of Minnesota,Minneapolis,MN"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,9,25]]},"reference":[{"key":"lt26286-bib-0001-20250824","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1111\/ajt.13099","article-title":"Early changes in liver distribution following implementation of share 35","volume":"15","year":"2015","journal-title":"Am J Transplant"},{"key":"lt26286-bib-0002-20250824","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1002\/sim.7532","article-title":"Measures of clustering and heterogeneity in multilevel Poisson regression analyses of rates\/count 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Transplant"},{"key":"lt26286-bib-0015-20250824","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1111\/ajt.15172","article-title":"Development and validation of an optimized prediction of mortality for candidates awaiting liver transplantation","volume":"19","year":"2019","journal-title":"Am J Transplant"},{"key":"lt26286-bib-0016-20250824","doi-asserted-by":"crossref","first-page":"1652","DOI":"10.1111\/j.1600-6143.2010.03127.x","article-title":"Hepatocellular carcinoma patients are advantaged in the current liver transplant allocation system","volume":"10","year":"2010","journal-title":"Am J Transplant"},{"key":"lt26286-bib-0017-20250824","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1002\/lt.25972","article-title":"A 6\u2010month report on the impact of the OPTN\/UNOS acuity circles policy change","volume":"27","year":"2021","journal-title":"Liver 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