Adult to Adult LDLT Cohort Study

描述(由申请人提供)：本提案的目的是证明宾夕法尼亚大学肝脏移植项目的医生和科学家小组有兴趣、基础设施和资源参与在等待移植的成年人中进行的活体供体肝脏移植(LDLT)队列研究。由于可供移植的供体器官有限，终末期肝病患者的护理进展受到阻碍。成人对成人LDLT有望显著扩大捐赠者的数量，并提供大量器官移植到指定的受者体内。然而，初步的结果是令人鼓舞的，还有许多与供者和受者的结果有关的问题，以及对这些患者的更好的管理是否可以改善这些结果。一项成人环境下LDLT的前瞻性多中心研究有望：1.收集和分析有助于建立可靠的供者选择标准的数据，检查与最佳短期和长期结果相关的手术技术，并推荐长期随访捐赠者的身体和心理健康的方法。2.确定与身体环境相比的受者结果，并研究结果是否受术前选择和准备、手术技术以及再生和免疫反应之间的相互关系的影响。3.研究供肾移植对临床实践和移植中的社会经济问题的影响。能否通过国家协作网络解决这些问题，将取决于参与该联盟的各中心的科学和业务表现。宾夕法尼亚大学移植中心致力于参与这些合作努力，并为旨在更好地了解LDLT的内科和外科问题的研究工作做出贡献。我们的提案分为三个部分。第一部分：描述宾夕法尼亚移植中心医生团队的资源和参与情况。第二部分：综合数据库开发的说明和策略。第三部分：两项研究提案，描述了四年来的研究努力，以确定：a.再生过程、移植物功能、同种异体免疫反应之间的相互关系。B.最低限度肝移植对捐赠者和接受者的生物、心理和社会影响。

DESCRIPTION (provided by applicant):The aim of this proposal is to demonstrate that the group of physicians and scientists at the Liver Transplant Program of the University of Pennsylvania has the interest, infrastructure and resources to participate in the Living Donor Liver Transplantation (LDLT) Cohort Study among adults awaiting transplantation. Progress in the care of patients suffering from end stage liver disease has been hampered by the limited availability of donor organs for transplantation. Adult to adult LDLT is expected to significantly expand the donor pool and provide numerous organs to be transplanted into designated recipients. The initial results are encouraging, however, there are many questions related to donor and recipient outcomes and whether better management of these patients can improve these results.A prospective mutli-center study of LDLT in the adult setting is expected to: 1. Collect and analyze data that will assist in the establishment of reliable criteria for donor selection, examine operative techniques that are associated with the best short and long term outcomes, and recommend methods for long-term follow up of the donor's physical and psychosocial well being. 2. Determine recipient outcomes when compared to the cadaveric setting and study whether results are affected by preoperative selection and preparation, operative techniques, and the interrelationship between regeneration and immune response. 3. Study the effects of LDLT on clinical practice and socioeconomic issues in transplantation. Success in addressing these problems through a national collaborative network will depend on the scientific and operational performance of the centers involved in the consortium. The Penn Transplant center is committed to participate in these collaborative efforts, and contribute to the research efforts that are aimed at better understanding of medical and surgical issues of LDLT.Our proposal is divided into three sections. Section one: A description of the resources and participation of the team of physicians at Penn Transplant Center. Section two: A description and strategy for the development of a comprehensive database. Section three: Two research proposals describing a four year research effort to identify: a. the interrelationship between the regenerative process, graft function, alloimmune response. and b. the biopsychosocial impact of LDLT on donors and recipients.