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团队有兴趣、有基础设施和资源参与等待移植的成人活体供肝移植（LDLT）队列研究。由于可供移植的供体器官有限，对终末期肝病患者的护理进展受到阻碍。成人对成人LDLT预计将大大扩大供体池，并提供大量器官移植到指定受体。最初的结果是令人鼓舞的，然而，还有许多与供体和受体结果有关的问题，以及对这些患者进行更好的管理是否可以改善这些结果。一项关于成人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，并推荐对供体身体和心理健康进行长期随访的方法。2. 确定接受者的结果，并与尸体环境进行比较，研究结果是否受到术前选择和准备、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。通过国家合作网络解决这些问题的成功与否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，并为研究工作做出贡献，旨在更好地了解LDLT的医学和外科问题。我们的建议分为三个部分。第一部分：描述宾夕法尼亚移植中心的资源和医生团队的参与情况。第二部分：综合数据库的描述和开发策略。第三部分：描述四年研究工作的两项研究建议：a.再生过程、移植物功能、同种免疫反应之间的相互关系。b. LDLT对供体和受者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.