*Purpose: Liver-intestine allocation is determined in the liver waitlist. This study aimed to evaluate effects of recent updates in liver allocation policy on waitlist outcomes in liver-intestine (multivisecral) transplant (MVT).

*Methods: We examined adult patients who were registered for liver-alone/liver-kidney transplant (LTA/LKT), and MVT between 2011 and 2018 by using the UNOS registry. Registration periods were grouped according to the recent revisions of liver allocation; pre-Share 35 (1/1/2011-6/17/2013), post-Share 35 (6/18/2013-1/10/2016), and MELDNa (1/11/2016-3/31/2018). 90-day waitlist mortality in MVT and LTA/LKT candidates were evaluated and effects of allocation changes were compared.

*Results: The number of LTA/LKT candidates listed with score of ≥29 significantly increased over periods (128, 149, and 189/month in pre-Share 35, post-Share 35, and MELDNa periods, respectively; P<0.001). A risk of 90 day-waitlist mortality in LTA/LKT candidates with MELD score of 20-28 decreased over periods (hazard ratio [HR], 0.91 and 0.82; P=0.042 and <0.001 for pre vs. post-Share 35 and post-Share 35 vs. MELDNa). In those with score of 29-34, a risk of 90-day morality significantly decreased in the MELDNa period (HR, 0.78; P<0.001 [ref. post-Share 35]). In MVT candidates, while no difference in 90-day mortality between pre and post-Share 35 (HR, 0.96; P=0.29), it significantly increased in the MELDNa period (HR, 1.08; P=0.02 [ref. post-Share 35]).

*Conclusions: Exception score for MVT candidates may need to be reconsidered, given the adverse impact of MELDNa based allocation which might be associated with the increasing number of high score patients.

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