Adult to adult living donor liver transplantation cohor*

描述（由申请人提供）：活体肝移植作为终末期肝病患者的治疗选择已迅速获得认可。在过去的5年里，LDLT从每年大约50 - 60例增长到今年的近500例，占美国所有肝移植的近10%。虽然小系列患者的报告表明，LDLT可以在技术上进行，相对较少的问题，没有对照研究评价这种程序相比，尸体移植的疗效。LDLT的仔细评估是必要的，因为这种程序对肝移植的潜在影响。LDLT队列研究是一项多中心对照研究，旨在测量LDLT供体和受体的结局。LDLT队列研究将解决几个重要问题。首先，将直接比较LDLT与尸体移植受者的存活率。由于LDLT受体的选择与尸体移植不同，因此必须仔细选择本研究的对照组。其次，LDLT可能通过减少移植前的等待时间来降低等待名单的死亡率。此外，有初步数据表明，患有丙型肝炎的LDLT接受者（这是LDLT最常见的适应症）可能比尸体接受者的结局更差。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个体，他接受了一个没有个人利益的腹部大手术。目前关于这种供体手术对供体生存和生活质量的影响的数据很少。因此，必须确定与LDLT相关的供体死亡率和发病率。最后，LDLT队列研究提供了一个直接计算尸体移植LDLT总费用的机会。随着LDLT队列研究的完成，医学界将更清楚地了解这一重要程序对肝移植，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.