Adult Live Donor Liver Transplant-A Comparative Analysis

可用尸体器官的短缺促使移植界考虑 供体肝移植（LDLT）作为尸体肝移植的有效替代方案 （CLT）。LDLT的潜在局限性主要包括：1）对其他患者的潜在风险 健康供体，2）与对照组相比，LDLT的移植物和患者结局的不确定性 到CLT。本提案的核心项目将比较LDLT接受者与 CLT，同时解决活体捐赠者的潜在并发症。此外，我们建议 分析两个不同的问题。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 金标准肝脏活检我们将比较移植脂肪肝的结果， 和尸体供体，评估两组的移植物和患者结局。我们还将评估 肝脂肪变性对活体供肝和受体肝再生的作用。我们 假设LDLT脂肪变性肝移植结果上级结果 在脂肪变性CLT接受者中获得。这第一个目标将有助于设计一个决策算法， 在CLT和LDLT中脂肪肝的同时， 脂肪变性其次，我们建议解决LDLT在多模式中的潜在作用， 肝细胞癌（HCC）的治疗。由于缺乏随机试验和大型 案例系列，这个问题最近已经解决了利用决策建模分析的研究。 第二个目标将提供临床数据来验证这些研究，并将比较CLT， 固有的等待时间，以LDLT，一个战略，理论上消除等待时间。我们 假设在LDLT中移植HCC的结果上级用 CLT。总之，这些研究将确定LDLT在美国的疗效，而重点是 供者问题（肝脂肪变性）和受者问题（HCC的特殊问题）都有帮助 描述LDLT相对于CLT的潜在优势。

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.