Adult to adult living donor liver transplantation cohor*

描述（由申请人提供）：活体供肝移植已迅速被接受为终末期肝病患者的一种治疗选择。在过去的5年中，LDLT从每年约50 - 60例增长到今年的近500例，占美国所有肝移植手术的近10%。虽然小系列患者的报告表明，LDLT在技术上可以相对较少地出现问题，但还没有对照研究评估该手术与尸体移植相比的疗效。由于该手术对肝移植的潜在影响，对LDLT进行仔细评估是必要的。LDLT队列研究是一项多中心对照研究，旨在测量LDLT供体和受体的结果。LDLT队列研究将解决几个重要问题。首先，将LDLT受体与尸体移植的存活率进行直接比较。由于LDLT受体的选择与尸体移植不同，本研究的对照组必须仔细选择。其次，LDLT可能通过减少移植前的等待时间来潜在地降低等候名单死亡率。此外，有初步数据表明，丙型肝炎（这是LDLT最常见的适应症）接受LDLT的患者可能比尸体接受LDLT的患者有更差的结果。必须评估LDLT对供体的影响。根据定义，活体捐赠者是一个健康的人，他接受了一个没有个人利益的大腹部手术。目前关于这种供体手术对供体生存和生活质量影响的数据很少。因此，有必要确定与LDLT相关的供体死亡率和发病率。最后，LDLT队列研究提供了直接计算尸体移植LDLT总成本的机会。随着LDLT队列研究的完成，医学界将更清楚地了解这一重要手术对肝移植、LDLT受体和LDLT供体的影响。

DESCRIPTION (provided by applicant): Living donor liver transplantation has rapidly gained acceptance as a treatment option for selected patients with end-stage liver disease. Over the past 5 years, LDLT has grown from approximately 50 - 60 cases per year to nearly 500 cases this year, accounting for nearly 10 % of all liver transplants performed in the United States. While reports of small series of patients have demonstrated that LDLT can be technically performed with relatively few problems, there have been no controlled studies evaluating the efficacy of this procedure compared to cadaveric transplantation. A careful evaluation of LDLT is necessary because of the potential impact of this procedure on liver transplantation. The LDLT Cohort Study is a multi-center controlled study designed to measure the outcomes of donors and recipients of LDLT. There are several important issues which the LDLT Cohort Study will address. First, a direct comparison of survival of recipients of LDLT compared to cadaveric transplantation will be made. Since selection of the LDLT recipient is different than cadaveric transplantation, the control group for this study must be carefully chosen. Second, LDLT may potentially reduce waiting list mortality by reducing waiting time prior to transplantation. In addition, there is preliminary data which suggests that LDLT recipients with hepatitis C (which is the most common indication for LDLT) may have a worse outcome compared to their cadaveric counterparts. The impact of LDLT on the donor must be evaluated. The live donor is by definition a healthy individual who undergoes a major abdominal surgery for no personal benefit. There currently are very little data on the impact of this donor surgery on the donor's survival and quality of life. Therefore, it is imperative to determine donor mortality and morbidity rates associated with LDLT. Finally, the LDLT Cohort Study provides an opportunity to directly the total cost of LDLT with cadaveric transplantation. With completion of the LDLT Cohort Study, the medical community will have a much clearer understanding of the impact of this important procedure on liver transplantation, LDLT recipients and LDLT donors.