Comparison of outcomes in high donation after circulatory death liver transplantation usage centers in the acuity circles era

INTRODUCTION: The recent acuity circles (AC) liver allocation policy has increased rates of donation after circulatory death (DCD) liver transplantation. We hypothesize that transplant centers with high-volume DCD graft usage may have differing outcomes. METHODS: All adult DCD transplant recipients in the United Network for Organ Sharing (UNOS) STAR file from January 11, 2016, to September 30, 2021, were included. Living liver grafts, pediatric, and nonkidney simultaneous transplantation were excluded. The top decile of DCD transplant centers by volume per year were identified. Six-month and 1-year patient and liver graft survival were compared with bottom 90% usage centers by using propensity score–matched fine gray regression models. Outcomes were stratified by pre-AC (January 11, 2016 to February 3, 2020) and post-AC (February 4, 2020 to September 30, 2020) eras (Figure). Transplant recipients that cross eras were censored on the last day of the pre-AC era. RESULTS: Included in this study were 2,299 DCD liver transplantation recipients : 2012 in pre-AC and 287 in post-AC eras. High DCD volume (top decile) centers had significantly improved 6-month (hazard ratio 0.32, 95% CI 0.11 to 0.91, p = 0.033) and 1-year (hazard ratio 0.42, 95% CI 0.17 to 0.98, p = 0.043) patient survival in the post-AC era compared with bottom 90% centers by volume. No significant differences were noted in 6-month or 1-year liver graft survival in either era. CONCLUSION: The top decile DCD transplantation volume centers have improved 6-month and 1-year patient survival compared with the lower volume centers with the introduction of the AC policy.Figure