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

We aimed to assess the impact of acuity circles (AC) allocation policy on ABO blood type–related disparities in liver transplant waitlist outcomes. This was a retrospective cohort study using national registry data from February 2002 to September 2023. Adults listed for liver transplant were included, excluding those with HCC exceptions and multi-organ listings. Adjusted Fine–Gray competing risk regression was used to evaluate transplant and waitlist mortality outcomes before and after AC policy implementation. A total of 179,376 waitlist candidates were included. Median time to transplant decreased across ABO groups in the post-AC era. In adjusted models, there was a significant change in time to transplant among ABO groups across eras ( p <0.001). There was a 10.7% disparity reduction in time to transplant for type B versus type AB (0.694 SHR post-AC vs. 0.627 SHR pre-AC), and a 4.3% disparity reduction in time to transplant for type O versus type AB (SHR 0.511 post-AC vs. 0.490 pre-AC). While there was a significant reduction in overall waitlist mortality in the post-AC era (SHR 0.605, 95% CI 0.486–0.753, p <0.001), there was no significant interaction between ABO group policy and era ( p =0.74). AC policy yielded more equitable transplant access overall by recipient ABO type, in particular for patients with type B blood.