Although early studies suggest the Acuity Circles (AC) allocation policy has increased access to deceased donor liver transplants (DDLTs) for patients with the highest MELD scores, changes in center- and region-level practices among patients with the highest MELD scores in response to AC are not well-characterized. OPTN/UNOS data were analyzed to compare center-level changes in the number of DDLTs based on allocation-MELD (aMELD) categories used for AC sharing performed in the 18-month periods before and after AC enactment on February 4, 2020. There was large center-level variation in the number and proportion of aMELD ≥ 37 DDLTs performed from pre-AC to AC period; 13 centers accounted for 196 of the 198 total net increase in aMELD ≥ 37 DDLTs performed after AC, 5 of these being from UNOS region 5. Similar center-level variation was seen for MELD 33–36 and MELD 29–32 DDLTs, with 17 centers and 14 centers, respectively, accounting for the entire net increase in DDLTs in the aMELD categories. In conclusion, AC increased access to livers for transplantation for high MELD patients nationally, but imbalances remain in transplant practice patterns at the center and regional levels. Longer-term study is necessary to assess effectiveness of AC in improving equitability of liver transplantations.

中文翻译：

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视力圈政策变化后肝移植实践的中心级和区域级变化

尽管早期研究表明 Acuity Circles (AC) 分配政策增加了 MELD 评分最高的患者获得已故供体肝移植 (DDLT) 的机会，但 MELD 评分最高的患者在中心和地区层面的实践发生了变化，以响应交流电没有很好的特征。分析了 OPTN/UNOS 数据，以比较 2020 年 2 月 4 日 AC 颁布前后 18 个月期间执行的 AC 共享所使用的分配 MELD (aMELD) 类别的 DDLT 数量的中心级变化。有从预 AC 到 AC 期间执行的 aMELD ≥ 37 DDLT 的数量和比例存在较大的中心水平变化；在 AC 后执行的 aMELD ≥ 37 DDLT 的 198 个净增加总数中，13 个中心占 196 个，其中 5 个来自 UNOS 区域 5。MELD 33-36 和 MELD 29-32 DDLT 也出现了类似的中心水平变化，分别有 17 个中心和 14 个中心，占 aMELD 类别中 DDLT 的全部净增长。总之，AC 在全国范围内增加了高 MELD 患者获得肝脏进行移植的机会，但在中心和地区层面的移植实践模式中仍然存在不平衡。需要更长期的研究来评估 AC 在改善肝移植公平性方面的有效性。