This year was notable for changes to exception points determined by the geographic median allocation Model for End‐Stage Liver Disease (MELD) and implementation of the National Liver Review Board, which took place on May 14, 2019. The national acuity circle liver distribution policy was also implemented but reverted to donor service area‐ and region‐based boundaries after 1 week. In 2019, growth continued in the number of new waiting list registrations (12,767) and transplants performed (8,896), including living‐donor transplants (524). Compared with 2018, living‐donor liver transplants increased 31%. Women continued to have a lower deceased­donor transplant rate and a higher pretransplant mortality rate than men. The median waiting time for candidates with a MELD of 15‐34 decreased, while the number of transplants performed for patients with exception points decreased. These changes may have been related to the policy changes that took effect in May 2019, which increased waiting list priority for candidates without exception status. Hepatitis C continued to decline as an indication for liver transplant, as the proportion of liver transplant recipients with alcohol‐related liver disease and clinical profiles consistent with non‐alcoholic steatohepatitis increased. Graft and patient survival have improved despite changing recipient demographics including older age, higher MELD, and higher prevalence of obesity and diabetes.

Data on adult liver transplants performed in the US in 2018 are notable for (1) continued growth in numbers of new waitlist registrants (11,844) and transplants performed (8250); (2) continued increase in the transplant rate (54.5 per 100 waitlist‐years); (3) a precipitous decline in waitlist registrations and transplants for hepatitis‐C‐related indications; (4) increases in waitlist registrants and recipients with alcoholic liver disease and with clinical profiles consistent with non‐alcoholic fatty liver disease; (5) increased use of hepatitis C virus antibody‐positive donor livers; and (6) continued improvement in graft survival despite changing recipient characteristics such as older age and higher rates of obesity and diabetes. Variability in transplant rates remained by candidate race, hepatocellular carcinoma status, urgency status, and geography. The volume of pediatric liver transplants was relatively unchanged. The highest rate of pre‐transplant mortality persisted for children aged younger than 1 year. Children underwent transplant at higher acuity than in the past, as evidenced by higher model for end‐stage liver disease/pediatric end‐stage liver disease scores and listings at status 1A and 1B at transplant. Despite higher illness severity scores at transplant, pediatric graft and patient survival posttransplant have improved over time.

Data on adult liver transplants performed in the US in 2017 are notable for (1) continued growth in numbers of new waitlist registrants (11,514) and of transplants performed (8,082); (2) continued increase in the transplant rate (51.5 per 100 waitlist-years); (3) a precipitous decrease in waitlist registrations and transplants for hepatitis C-related indications; (4) reciprocal increases in waitlist registrants and recipients with alcoholic liver disease and with clinical profiles consistent with non-alcoholic fatty liver disease; and (5) continued improvement in graft survival despite changing recipient characteristics such as older age and higher rates of obesity. Variability in transplant rates remained by candidate race, presence of hepatocellular carcinoma, urgency status (status 1A versus model for end-stage liver disease (MELD) score >35), and geography. More than half

Acuity circles (AC), the new liver allocation system, was implemented on February 4, 2020. Difference‐in‐differences analyses estimated the effect of AC on adjusted deceased donor transplant and offer rates across Pediatric End‐Stage Liver Disease (PELD) and Model for End‐Stage Liver Disease (MELD) categories and types of exception statuses. The offer rates were the number of first offers, top 5 offers, and top 10 offers on the match run per person‐year. Each analysis adjusted for candidate characteristics and only used active candidate time on the waiting list. The before‐AC period was February 4, 2019, to February 3, 2020, and the after‐AC period was February 4, 2020, to February 3, 2021. Candidates with PELD/MELD scores 29 to 32 and PELD/MELD scores 33 to 36 had higher transplant rates than candidates with PELD/MELD scores 15 to 28 after AC compared with before AC (transplant rate ratios: PELD/MELD scores 29‐32, 2.343.324.71; PELD/MELD scores 33‐36, 1.702.513.71). Candidates with PELD/MELD scores 29 or higher had higher offer rates than candidates with PELD/MELD scores 15 to 28, and candidates with PELD/MELD scores 29 to 32 had the largest difference (offer rate ratios [ORR]: first offers, 2.773.955.63; top 5 offers, 3.904.394.95; top 10 offers, 4.855.305.80). Candidates with exceptions had lower offer rates than candidates without exceptions for offers in the top 5 (ORR: hepatocellular carcinoma [HCC], 0.680.770.88; non‐HCC, 0.730.810.89) and top 10 (ORR: HCC, 0.590.650.71; non‐HCC, 0.690.750.81). Recipients with PELD/MELD scores 15 to 28 and an HCC exception received a larger proportion of donation after circulatory death (DCD) donors after AC than before AC, although the differences in the liver donor risk index were comparatively small. Thus, candidates with PELD/MELD scores 29 to 34 and no exceptions had better access to transplant after AC, and donor quality did not notably change beyond the proportion of DCD donors.

Intestine transplant can be life‐saving and can improve quality of life for patients with intestinal failure. Medical and surgical advances in treatment of intestinal failure over the past 10 to 15 years have resulted in fewer patients being added to the waiting list for intestine transplant alone or for intestine transplant in combination with liver transplant (and sometimes other organs). Consequently, fewer transplants are being performed. The numbers of listings and transplants fell to new lows in 2019. The number of programs performing transplants in at least one patient in 2019 was the lowest in the last decade, equal to 2014, at 15. Graft failure plateaued over the past decade, but early graft loss has increased in the past 2 years, notably in recipients of a combined liver and intestine allograft. Five‐year patient survival for transplants in 2012‐2014 varied little by graft type.

Purpose This prospective study was conducted to determine predictors of epidermal thickening during and after whole breast radiotherapy (XRT) using objective measurements acquired with ultrasound. Methods and Materials Following breast conserving surgery, 70 women received a definitive course of whole breast XRT (50 Gy plus boost). Prior to XRT, at week 6 of XRT, and 6 weeks post XRT, subjects underwent objective ultrasound measurements of epidermal thickness over the lumpectomy cavity and all four quadrants of the treated breast. A skin thickness ratio (STRA) was then generated normalizing for corresponding measurements taken of the untreated breast. Results Baseline measurements indicated that 87% of patients had skin thickening in the treated versus untreated breast (mean increase of 27%, SD of 0.29) prior to XRT. The STRA increased significantly by week 6 of XRT (mean 25% (SD .46) and continued to increase significantly 6 weeks post XRT (mean 33% (SD .46) above baseline measurements (p<0.001 for both timepoints). In multivariable analysis, breast volume (p=0.003) and surgical evaluation of the axilla with full lymph node dissection (p<0.05) predicted for more severe changes in STRA 6 weeks after XRT compared with baseline. STRA measurements correlated with physician ratings of skin toxicity according to RTOG grading criteria. Conclusions This is one of the first studies to objectively document that lymph node surgery impacts XRT-induced skin thickening in breast cancer patients. Surgical evaluation of the axilla with a complete lymph node dissection was associated with the most severe XRT-induced skin changes following XRT completion. These results may inform future studies aimed at minimizing side effects of XRT and surgery, particularly when surgical lymph node assessments may not alter breast cancer management or outcome.

Despite medical and surgical advances in treatment of intestinal failure, intestine transplant still plays an important role. However, the number of new patients added to the intestine transplant waiting list has decreased over the past decade, reaching a low of 135 in 2018. The number of intestine donors also decreased, reaching a low of 106 in 2018, and the number of intestine transplants performed declined to its lowest level, 104, of which 59% were intestine‐liver transplants. Graft failure has plateaued over the past decade. Patient survival for transplants in 2011‐2013 varied by age and transplant type. Patient survival was lowest for adult intestine‐liver recipients (1‐and 5‐year survival 66.7% and 49.1%, respectively) and highest for pediatric intestine recipients (1‐and 5‐year survival 89.1% and 76.4%, respectively).

Opportunities continue to be lost with a high rate of kidneys recovered for transplant but not utilized, particularly those considered less than ideal quality. The Organ Procurement and Transplantation Network (OPTN) Organ Center is tasked with allocating arguably the most difficult‐to‐place kidneys, and we hypothesized an accelerated placement pathway would increase utilization of kidneys placed by the Organ Center. The Kidney Accelerated Placement (KAP) project, implemented by the Organ Center from July 18, 2019 to July 15, 2020, aimed to offer kidneys with a high kidney donor profile index to programs that had a history of accepting such organs. We compared OPTN kidney match run, donor, and transplant recipient data during the project period and 1 year prior. There was no statistically significant change in the percentage of KAP‐eligible donors accepted during the project period (16.4%) compared to the prior year (17.5%). Conversion from acceptance to transplant was higher under KAP (72.7% vs. 71.2%), though not significant. Waiting to accelerate placement after kidneys have been declined by multiple transplant programs locally and regionally is an intervention that may come too late to effectively increase utilization. Transplant rates of nationally shared and marginal kidneys remain a challenge, and future iterations of this project should be investigated.