Influence of Acuity Circles on Hepatocellular Carcinoma and the Interaction of Gender and Race in Liver Transplantation

Ahila Manivannan ¹, Anjana Pillai ², AnnMarie Liapakis ³

⁰Internal Medicine, Henry Ford Health, Detroit, Michigan, USA.

Clinical Transplantation +

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December 2, 2024

View abstract on PubMed

Summary

The liver transplant allocation policy using acuity circles (ACs) did not change racial and gender disparities in deceased donor liver transplant (DDLT) access or waitlist mortality. Black and Hispanic women faced worse outcomes than White women, and men generally fared better than women across racial groups.

Area Of Science

Transplantation research
Health equity
Organ allocation policy

Background

The implementation of acuity circles (ACs) aimed to standardize liver transplant allocation.
Previous allocation systems showed disparities based on race and gender.
The impact of ACs on these intersecting disparities remained unexamined.

Purpose Of The Study

To investigate the effect of the AC policy on liver transplant waitlist mortality and deceased donor liver transplant (DDLT) receipt.
To analyze the interaction between race and gender on these outcomes post-AC implementation.
To assess the influence of hepatocellular carcinoma (HCC) diagnosis on transplant outcomes under the AC policy.

Main Methods

Analysis of adult patients listed for DDLT from April 2017 to October 2022 (pre- and post-AC).
Utilized data from the United Network for Organ Sharing (UNOS).
Employed Fine-Gray sub-distribution hazard models to assess AC indicators, race, gender interactions, and HCC status.

Main Results

No significant 3-way interaction (AC by race by gender) was found, indicating consistent effects of race and gender pre- and post-AC.
Black and Hispanic women had lower DDLT receipt and higher waitlist mortality risk than White women.
Men across racial groups had better DDLT receipt likelihood and lower waitlist mortality risk than their female counterparts. HCC diagnosis increased DDLT chance but also waitlist mortality risk, with attenuated effects post-AC.

Conclusions

The AC policy did not eliminate existing racial and gender disparities in liver transplantation.
Disparities persist, with women, particularly Black and Hispanic women, experiencing worse outcomes.
This study highlights the need for further policy evaluation to address persistent inequities in organ allocation.

Keywords:

disparities ethnicity/race gender