*Purpose: Acuity circles (AC) allocation was implemented on 2/4/2020 with a goal of removing DSA and region from liver allocation and sharing livers more broadly. This abstract examines several health equity metrics to determine if broader sharing had unintended consequences at various geographic levels.

*Methods: OPTN waitlist and transplant data were analyzed 18 months pre- (8/6/2018-2/3/2020) and post- (2/4/2020-8/3/2021) AC implementation. We focus on biological, sociodemographic, and environmental determinants of health.

*Results: There were no substantial differences in these measures except a slight shift in community health risk score (CHRS) and primary insurance nationally (Table 1); however, this varied by state. Change in proportions pre- to post-policy were small for most states by blood type (interquartile range (IQR): -2.6%, 2.5%), female sex (IQR:-2.5%, 4%), and race/ethnicity (IQR: -1.3%, 1.1%), while slightly higher for private vs. public insurance (IQR:-6.2%, 6.6%). Only a handful of states experienced >10% change in categories of these measures. Seven states had >10% decrease and 2 had >10% increase in the proportion of recipients with private insurance. The largest changes in CHRS by state occur in the proportion of recipients in CHRS 0-10 and 11-20 (low risk) areas (Figure 1a). Two states experienced >1% decrease (OK:-6%, KS:-10%) in recipients in rural areas, while 10 states experienced >1% increase (2 to 6%) (Figure 1b).

*Conclusions: Changes in health equity measures differed by state, with less substantial changes for recipients in high risk CHRS and rural areas. Slight changes by race/ethnicity indicate little disruption in sociodemographic measures, while patterns for biological measures of recipient blood type and sex indicate shifts in recipient populations for a handful of states. Concerns about AC exacerbating disparities for vulnerable populations have not borne out, although data will be further monitored closely.

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