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Impact of acuity circles policy on ABO blood type-related waitlist outcomes in liver transplantation

Dilara Hatipoglu1,2,3, Anna Goebel4, K Rajender Reddy1

  • 1Division of Gastroenterology and Hepatology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
|September 22, 2025
PubMed

Insights

The acuity circles (AC) policy improved liver transplant equity across ABO blood types, particularly for type B recipients. This policy reduced disparities in transplant wait times and overall waitlist mortality.

Area of Science:

  • Transplantation research
  • Organ allocation policy
  • Health equity

Background:

  • ABO blood type is a significant factor in liver transplant waitlist outcomes.
  • Previous allocation policies may have contributed to disparities among blood types.

Purpose of the Study:

  • To evaluate the impact of the acuity circles (AC) allocation policy on ABO blood type-related disparities in liver transplant waitlist outcomes.
  • To assess changes in transplant wait times and waitlist mortality before and after AC policy implementation.

Main Methods:

  • Retrospective cohort study using national registry data (February 2002 - September 2023).
  • Included adult liver transplant candidates, excluding HCC exceptions and multi-organ listings.
  • Used Adjusted Fine-Gray competing risk regression to analyze outcomes.

Main Results:

  • Median time to transplant decreased across ABO groups post-AC policy.
  • Significant reduction in time to transplant disparity for type B vs. AB (10.7%) and type O vs. AB (4.3%).
  • Overall waitlist mortality significantly reduced in the post-AC era, with no significant interaction by ABO group.

Conclusions:

  • The AC allocation policy has led to more equitable liver transplant access across recipient ABO types.
  • The policy particularly benefited patients with type B blood, reducing transplant wait time disparities.
  • Further research may explore long-term impacts and refinements for optimal equity.

Keywords:
blood group incompatibilityliver diseasespolicytissue and organ procurementtissue donorstransplant recipients

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