Impact of Changes in Liver Allocation System on the Utility of Donor Liver Biopsy for Liver Transplantation

The impact of the acuity circles (AC) deceased donor liver allocation policy on graft utilization remains unclear, with recent studies suggesting a decline in liver utilization despite an increase in potential donors. This study aimed to compare deceased donor liver biopsy (DDLB) rates and identify factors associated with DDLB utilization before and after AC implementation.

Data from the Scientific Registry of Transplant Recipients (SRTR) for January 2018 to June 2021 were retrospectively analyzed, dividing donors into pre-AC (Jan 2018-Feb 2020) and post-AC (Feb 2020-June 2021) periods. The study included 16,969 donor's pre-AC and 11,156 donor's post-AC, categorized into DDLB and non-DDLB groups. Primary endpoints included DDLB rates, graft nonuse rates, patient survival, and death-censored graft survival (DCGS). Statistical analyses involved chi-square tests, t-tests, and multivariate logistic regression.

DDLB utilization increased from 38.2% pre-AC to 40.8% post-AC (P < .001). Post-AC, the DDLB group had a higher proportion of male donors and older donors. One-year patient survival rates decreased post-AC in both groups (P < .001), while DCGS rates remained stable. Graft nonuse rates showed no significant differences. Multivariate analysis identified the AC policy, donor age, diabetes, and donation after circulatory death as significant predictors of DDLB use, with the AC policy independently increasing DDLB likelihood by 20% (OR = 1.2, CI: 1.13-1.26, P < .001).

The AC policy has led to increased DDLB utilization, likely due to broader recipient selection. These findings suggest the need for standardized guidelines to optimize DDLB use while balancing recipient selection with associated risks.