Post‐transplant outcomes and financial burden of donation after circulatory death donor liver transplant after the implementation of acuity circle policy

Abstract

AbstractBackgroundAfter implementation of the Acuity Circles (AC) allocation policy, use of DCD liver grafts has increased in the United States.MethodsWe evaluated the impact of AC on rates of DCD‐liver transplants (LT), their outcomes, and medical costs in a single practice. Adult LT patients were classified into three eras: Era 1 (pre‐AC, 1/01/2015–12/31/2017); Era 2 (late pre‐AC era, 1/01/2018–02/03/2020); and Era 3 (AC era, 05/10/2020–09/30/2021).ResultsA total of 520 eligible LTs were performed; 87 were DCD, and 433 were DBD. With each successive era, the proportion of DCD increased (Era 1: 11%; Era 2: 20%; Era 3: 24%; p < .001). DCD recipients had longer ICU stays, higher re‐admission/re‐operation rates, and higher incidence of ischemic cholangiopathy compared to those with DBD. Direct, surgical, and ICU costs during first admission were higher with DCD than DBD (+8.0%, p < .001; +4.2%, p < .001; and +33.3%, p = .001). DCD‐related costs increased after Era 1 (Direct: +4.9% [Era 2 vs. 1] and +12.4% [Era 3 vs. 1], p = .04; Surgical: +17.7% and +21.7%, p < .001). In the AC era, there was a significantly higher proportion of donors ≥50 years, and more national organ sharing. Compared to DCD from donors <50 years, DCD from donors ≥50 years was associated with significantly higher total direct, surgical, and ICU costs (+12.6%, p = .01; +9.5%, p = .01; +84.6%, p = .03).ConclusionsThe proportion of DCD‐LT, especially from older donors, has increased after the implementation of AC policies. These changes are likely to be associated with higher costs in the AC era.