Living Donor Liver Transplant - Predictive Models for Long-Term Health Outcomes

描述（由申请人提供）：本提案的总体目标是解决A2 ALL资助机会公告的目标，以提高对活体供体长期健康和福祉以及活体供体肝移植（LDLT）疗效的了解。主要目标包括：1）表征预测长期健康和患者报告结果的风险、介质、调节因子和结果，包括潜在活体肝脏供体的健康，以及2）表征预测LDLT接受者的长期结果的风险、介质、调节因子和结果，以及LDLT长期结果的复合供体-接受者预测模型。迄今为止，A2 ALL研究已经清楚地证明LDLT是死亡供体肝移植（DDLT）的安全有效的替代方案。更具体地说，A2 ALL的数据量化了短期供体发病率，并表明LDLT受体的短期发病率、资源利用和其他受体临床结果与DDLT相当。然而，活体捐赠的长期结果仍然不确定，特别是捐赠对活体捐赠者长期健康和福祉的影响。虽然正在使用国家登记处的数据为DDLT开发预测结果的风险因素，但这些登记处目前尚未收集开发针对活体供体和LDLT接受者结果的综合风险预测模型所需的所有措施。虽然已经从目前的A2 ALL队列中收集了关于供体和受体特征的数据，但需要开发其他工具，包括适当的措施，以充分表征与长期健康状况和患者报告的结局（包括福祉）相关的风险。最后，很少有知识和缺乏标准，重点是复杂的医疗过程中涉及移植一般，特别是在LDLT，介导和缓和的影响，风险因素对结果。了解LDLT过程和风险因素是特别相关的，因为与患者安全相关的医疗保健过程的增强（例如，临床医生与临床医生的通信，护理协调）和临床医生与患者的通信（例如，信息交流、知情同意）改善了其他保健领域的健康成果。因此，显然需要通过探索特定风险因素的影响以及医疗保健过程介质对长期健康和福祉结果领域的影响来扩大对LDLT的研究。 公共卫生相关性：这项研究将描述影响活体捐赠者和活体捐赠者接受者长期健康状况和福祉的因素。具体而言，通过提高安全性，知情同意和生活质量的知识，该提案将有助于扩大活体肝脏供体的库。

DESCRIPTION (provided by applicant): The overarching goal of this proposal is to address the A2ALL Funding Opportunity Announcement objective to improve understanding of long-term health and well-being of living donors and on the efficacy of living donor liver transplantation (LDLT). Primary aims include: 1) characterizing risks, mediators, moderators, and outcomes that predict the long-term health and patient reported outcomes including well-being of potential living liver donors, and 2) characterizing risks, mediators, moderators, and outcomes that predict long-term outcomes of LDLT recipients and a composite donor-recipient predictive model for long-term outcomes of LDLT. A2ALL studies thus far have clearly demonstrated (LDLT) is a safe and effective alternative to deceased donor liver transplantation (DDLT). More specifically, data from A2ALL have quantified short-term donor morbidity and shown that LDLT recipient short-term morbidity, resource utilization, and other recipient clinical outcomes are comparable to those of DDLT. However, the long-term outcomes of living donation remain undefined, especially the impact of donation on the long-term health and well-being of living donors. Although risk factors that predict outcome are being developed for DDLT using data from national registries, such registries do not currently gather all of the measures needed to develop comprehensive risk predictor models specific to the outcomes of both the living donor and the LDLT recipient. While data on both donor and recipient characteristics have been collected from the current A2ALL cohorts, additional instruments need to be developed that include appropriate measures to fully characterize the risks related to long-term health status and patient reported outcomes including well-being. Finally, there is little knowledge and a lack of standards that focus on the complex healthcare processes involved in transplantation in general, and in LDLT in particular, that mediate and moderate the impact of risk factors on outcomes. Understanding LDLT processes and risk factors is particularly relevant since the enhancement of healthcare processes related to patient safety (e.g., clinician to clinician communication, coordination of care) and to clinician-patient communication (e.g., information exchange, informed consent) have improved health outcomes in other healthcare arenas. Therefore, there is a clear need to expand research on LDLT by exploring the impact of specific risk factors and the effect of healthcare process mediators on outcome domains of long-term health and well-being. PUBLIC HEALTH RELEVANCE: This research will characterize the factors that influence living donors' and living donor recipients' long-term health status and well-being. Specifically, by advancing knowledge of safety, informed consent, and quality of life this proposal will help to expand the pool of living liver donors.