Ivanics , TommyVianna , RodrigoKubal , Chandrashekhar A.Iyer , Kishore R.Mazariegos , George V.Matsumoto , Cal S.Mangus , RichardBeduschi, ThiagoAbouljoud , MarwanFridell , Jonathan A.Nagai, Shunji2024-06-212024-06-212022-02Ivanics, T., Vianna, R., Kubal, C. A., Iyer, K. R., Mazariegos, G. V., Matsumoto, C. S., Mangus, R., Beduschi, T., Abouljoud, M., Fridell, J. A., & Nagai, S. (2022). Impact of the acuity circle model for liver allocation on multivisceral transplant candidates. American Journal of Transplantation, 22(2), 464–473. https://doi.org/10.1111/ajt.16803https://hdl.handle.net/1805/41745Liver allocation was updated on February 4, 2020, replacing a Donor Service Area (DSA) with acuity circles (AC). The impact on waitlist outcomes for patients listed for combined liver-intestine transplantation (multivisceral transplantation [MVT]) remains unknown. The Organ Procurement and Transplantation Network/United Network for Organ Sharing database was used to identify all candidates listed for both liver and intestine between January 1, 2018 and March 5, 2021. Two eras were defined: pre-AC (2018–2020) and post-AC (2020–2021). Outcomes included 90-day waitlist mortality and transplant probability. A total of 127 adult and 104 pediatric MVT listings were identified. In adults, the 90-day waitlist mortality was not statistically significantly different, but transplant probability was lower post-AC. After risk-adjustment, post-AC was associated with a higher albeit not statistically significantly different mortality hazard (sub-distribution hazard ratio[sHR]: 8.45, 95% CI: 0.96–74.05; p = .054), but a significantly lower transplant probability (sHR: 0.33, 95% CI: 0.15–0.75; p = .008). For pediatric patients, waitlist mortality and transplant probability were similar between eras. The proportion of patients who underwent transplant with exception points was lower post-AC both in adult (44% to 9%; p = .04) and pediatric recipients (65% to 15%; p = .002). A lower transplant probability observed in adults listed for MVT may ultimately result in increased waitlist mortality. Efforts should be taken to ensure equitable organ allocation in this vulnerable patient population.en-USAttribution-NonCommercial-NoDerivatives 4.0 Internationalclinical research/practicehealth services and outcomes researchintestine/multivisceral transplantationliver transplantation/hepatologyorgan allocationorgan procurement and allocationorgan procurement and transplantation network (OPTN)registry/registry analysisunited network for organ sharing (UNOS)Article