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, _2.343.32_4.71; PELD/MELD scores 33-36, _1.702.51_3.71). 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, _2.773.95_5.63; top 5 offers, _3.904.39_4.95; top 10 offers, _4.855.30_5.80). Candidates with exceptions had lower offer rates than candidates without exceptions for offers in the top 5 (ORR: hepatocellular carcinoma [HCC], _0.680.77_0.88; non-HCC, _0.730.81_0.89) and top 10 (ORR: HCC, _0.590.65_0.71; non-HCC, _0.690.75_0.81). 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.

中文翻译：

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Acuity Circles 对已故供体移植的影响以及终末期肝病评分和异常状态模型的报价率

新的肝脏分配系统 Acuity circles (AC) 于 2020 年 2 月 4 日实施。差异分析估计了 ​​AC 对调整后的已故供体移植的影响，并提供了小儿终末期肝病 (PELD) 和终末期肝病 (MELD) 类别和异常状态类型的模型。出价率是每人每年比赛中首次出价、前 5 名出价和前 10 名出价的数量。每个分析都针对候选人特征进行了调整，并且仅使用等候名单上的活跃候选人时间。AC前期间为2019年2月4日至2020年2月3日，AC后期间为2020年2月4日至2021年2月3日。_2.34 3.32 _4.71；PELD/MELD 得分 33-36，1.70 _{2.51 3.71}）。PELD/MELD 分数为 29 或更高的候选人的录取率高于 PELD/MELD 分数为 15 至 28 的候选人，PELD/MELD 分数为 29 至 32 的候选人差异最大（录取率比率 [ORR]：首次录取，_2.77 3.95 _5.63；前 5 个报价，_3.90 4.39 _4.95；前 10 个报价，_4.85 5.30 _5.80）。在前 5 名中，有例外的候选人的录取率低于没有例外的候选人（ORR：肝细胞癌 [HCC]，_0.68 0.77 _0.88；非 HCC，_0.730.81 _0.89）和前 10 名（ORR：HCC，_0.59 0.65 _0.71；非 HCC，_0.69 0.75 _0.81）。PELD/MELD 评分为 15 至 28 分且 HCC 例外的接受者在 AC 后接受了比 AC 前更大比例的循环死亡 (DCD) 捐献者，尽管肝脏供体风险指数的差异相对较小。因此，PELD/MELD 得分为 29 至 34 且无一例外的候选人在 AC 后更容易获得移植，并且供体质量没有明显变化超过 DCD 供体的比例。