Adult Live Donor Liver Transplant-A Comparative Analysis

描述(由申请人提供)：可用身体器官的短缺促使移植团体考虑将活体供肝移植(LDLT)作为身体肝移植(CLT)的有效替代方案。LDLT的潜在局限性主要包括：1)对其他健康供者的潜在风险；2)与CLT相比，LDLT在移植物和患者预后方面的不确定性。这项提议的核心项目将比较LDLT和CLT受者的结果，同时解决对活体捐赠者的潜在并发症。此外，我们建议分析两个不同的问题。首先，我们将评估LDLT和CLT中供体肝脏的脂肪变性。我们将对活体供者脂肪变性的新的非侵入性测量与目前的金标准--肝脏活检--进行比较。我们将比较活体和身体供者脂肪变性肝脏移植的结果，评估两组的移植物和患者结果。我们还将评估肝脏脂肪变性在活体供体和受体肝脏再生中的作用。我们假设在脂肪变性的LDLT肝脏中移植的结果优于脂肪变性的CLT接受者的结果。这第一个目标将有助于设计一种在CLT和LDLT中使用脂肪变性肝脏的决策算法，同时验证肝脏脂肪变性的非侵入性测量。其次，我们建议探讨LDLT在肝细胞癌(HCC)多模式治疗中的潜在作用。鉴于缺乏随机试验和大型病例系列，这一问题最近在利用决策建模分析的研究中得到了解决。第二个目标将提供临床数据来验证这些研究，并将CLT与其固有的等待时间与LDLT进行比较，LDLT是一种理论上消除等待时间的策略。我们假设肝细胞癌在LDLT中移植的结果优于CLT的结果。总的来说，这些研究将确定LDLT在美国的疗效，同时关注供体问题(肝脏脂肪变性)和受体问题(肝细胞癌的特殊问题)将有助于勾勒出LDLT相对于CLT的潜在优势。

DESCRIPTION (provided by applicant):The shortage of available cadaver organs has prompted the transplant community to consider living donor liver transplantation (LDLT) as an effective alternative to cadaveric liver transplantation (CLT). The potential limitations of LDLT consist primarily of 1) the potential risk to an otherwise healthy donor, and 2) the uncertainty regarding graft and patient outcomes for LDLT as compared to CLT. The core project of this proposal will compare outcomes for recipients of LDLT to those of CLT, while addressing the potential complications to living donors. In addition, we propose to analyze two separate issues. First, we will evaluate donor hepatic steatosis in both LDLT and CLT. We will compare novel non-invasive measurements of steatosis in living donors with the current gold standard, a liver biopsy. We will compare the results of transplanting steatotic livers from living and cadaveric donors, assessing graft and patient outcomes in both groups. We will also evaluate the role of hepatic steatosis on liver regeneration in both the living donor and recipient. We hypothesize that outcome of transplantation in steatotic livers of LDLT is superior to results obtained in steatotic CLT recipients. This first aim will help design a decision algorithm for the use of steatotic livers in both CLT and LDLT while validating non-invasive measurements of hepatic steatosis. Second, we propose to address the potential role for LDLT in the multimodal management of hepatocellular carcinoma (HCC). Given the lack of randomized trials and large case series, this issue has been recently addressed in studies utilizing decision-modeling analysis. This second aim will provide clinical data to validate these studies, and will compare CLT, with its inherent waiting times, to LDLT, a strategy that theoretically eliminates waiting times. We hypothesize that the outcome of transplantation of HCC in LDLT is superior to results obtained with CLT. In the aggregate, these studies will define the efficacy of LDLT in the US, while a focus on both a donor issue (hepatic steatosis) and a recipient issue (the special problem of HCC) will help delineate the potential advantages of LDLT over CLT.