*Purpose: In February, 2020, UNOS implemented a new liver allocation system incorporating a combination of acuity based on MELD/PELD score and distance from the donor hospital, utilizing concentric circles of increasing distance (acuity circles). This study examines the effects of the policy on liver allocation.

*Methods: OPTN data was analyzed for patients placed on the liver transplant waitlist between 8/2015 and 7/2021. Retransplant and multiorgan transplant patients were excluded. Patients were grouped according to age at listing concordant with OPTN stratification: pediatric < 12 years of age, adolescent 12-17, and adult 18 or older. Wait time, lab MELD/PELD score at the time of transplant, allocation MELD/PELD score, and graft type (donor after brain death, donor after cardiac death, split liver, living donor) were assessed.

*Results: Waiting time for all age groups was reduced after the implementation of acuity circles (Fig. 1). Adult patients experienced the greatest reduction in wait time. The average MELD score at transplant for adults increased after the institution of the new allocation system. Adult patients received more transplants from all donor types after the new policy.

*Conclusions: The new acuity circle allocation system for liver transplant patients has decreased the wait time for patients on the list awaiting transplant and is associated with an increase in the number of transplants from all donor types in adult patients. Interestingly, the average MELD score at transplant in adults has increased, despite the decrease in wait time.

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