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等待移植的成人活体供者肝移植（LDLT）队列研究。终末期肝病患者的护理进展受到移植供体器官有限的阻碍。成人间LDLT有望显著扩大供体库，并提供大量器官移植到指定受体。初步结果是令人鼓舞的，然而，还有许多问题与供体和受体的结果有关，以及更好的管理这些患者是否可以改善这些结果。收集和分析有助于建立可靠的供体选择标准的数据，检查与最佳短期和长期结果相关的手术技术，并推荐长期随访供体身体和心理健康的方法。2.与尸体环境相比，确定受体结局，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LDLT对移植临床实践和社会经济问题的影响。通过一个全国性的合作网络成功地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业绩。宾夕法尼亚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的医疗和手术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：综合数据库的开发描述和策略。第三部分：两个研究建议，描述了四年的研究工作，以确定：a。再生过程、移植物功能、同种免疫反应之间的相互关系。和B. LDLT对供体和受体的生物心理社会影响。

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.