Adult Live Donor Liver Transplant-A Comparative Analysis

描述（由申请人提供）：可用尸体器官的短缺促使移植界考虑将活体肝移植（LDLT）作为尸体肝移植（CLT）的有效替代方案。LDLT的潜在局限性主要包括：1）对其他健康供体的潜在风险，以及2）与CLT相比，LDLT的移植物和患者结局的不确定性。该提案的核心项目将比较LDLT和CLT接受者的结果，同时解决活体捐赠者的潜在并发症。此外，我们建议分析两个独立的问题。首先，我们将评估LDLT和CLT中的供体肝脏脂肪变性。我们将比较新的非侵入性测量脂肪变性的活体捐赠者与目前的金标准，肝活检。我们将比较活体和尸体供者脂肪肝移植的结果，评估两组移植物和患者的结局。我们也将评估肝脂肪变性对活体供者和受体肝再生的作用。我们推测，在脂肪变性肝的LDLT移植的结果上级在脂肪变性CLT受体获得的结果。这第一个目标将有助于设计一种决策算法，用于在CLT和LDLT中使用脂肪肝，同时验证肝脂肪变性的非侵入性测量。第二，我们提出LDLT在肝细胞癌（HCC）多模式治疗中的潜在作用。由于缺乏随机试验和大型病例系列，这个问题最近已经在利用决策建模分析的研究中得到了解决。第二个目标将提供临床数据来验证这些研究，并将比较CLT及其固有的等待时间与LDLT，LDLT是一种理论上消除等待时间的策略。我们假设肝细胞癌移植在LDLT中的结果比CLT获得的结果更上级。总的来说，这些研究将确定LDLT在美国的疗效，而对供体问题（肝脂肪变性）和受体问题（HCC的特殊问题）的关注将有助于描述LDLT相对于CLT的潜在优势。

DESCRIPTION (provided by applicant):The shortage of available cadaver organs has prompted the transplant community to consider living donor liver transplantation (LDLT) as an effective alternative to cadaveric liver transplantation (CLT). The potential limitations of LDLT consist primarily of 1) the potential risk to an otherwise healthy donor, and 2) the uncertainty regarding graft and patient outcomes for LDLT as compared to CLT. The core project of this proposal will compare outcomes for recipients of LDLT to those of CLT, while addressing the potential complications to living donors. In addition, we propose to analyze two separate issues. First, we will evaluate donor hepatic steatosis in both LDLT and CLT. We will compare novel non-invasive measurements of steatosis in living donors with the current gold standard, a liver biopsy. We will compare the results of transplanting steatotic livers from living and cadaveric donors, assessing graft and patient outcomes in both groups. We will also evaluate the role of hepatic steatosis on liver regeneration in both the living donor and recipient. We hypothesize that outcome of transplantation in steatotic livers of LDLT is superior to results obtained in steatotic CLT recipients. This first aim will help design a decision algorithm for the use of steatotic livers in both CLT and LDLT while validating non-invasive measurements of hepatic steatosis. Second, we propose to address the potential role for LDLT in the multimodal management of hepatocellular carcinoma (HCC). Given the lack of randomized trials and large case series, this issue has been recently addressed in studies utilizing decision-modeling analysis. This second aim will provide clinical data to validate these studies, and will compare CLT, with its inherent waiting times, to LDLT, a strategy that theoretically eliminates waiting times. We hypothesize that the outcome of transplantation of HCC in LDLT is superior to results obtained with CLT. In the aggregate, these studies will define the efficacy of LDLT in the US, while a focus on both a donor issue (hepatic steatosis) and a recipient issue (the special problem of HCC) will help delineate the potential advantages of LDLT over CLT.