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A2ALL资助机会公告的目标，以提高对活体供体的长期健康和福祉以及活体供体肝移植（LDLT）功效的理解。主要目的包括：1)表征预测长期健康和患者报告的结果（包括潜在活体肝供体的健康状况）的风险、中介、调节因子和结果；2)表征预测LDLT受体长期结果的风险、中介、调节因子和结果，以及LDLT长期结果的复合供体-受体预测模型。到目前为止，A2ALL研究已经清楚地表明（LDLT）是一种安全有效的替代已故供体肝移植（DDLT）的方法。更具体地说，A2ALL的数据量化了短期供体发病率，并显示LDLT受体短期发病率、资源利用率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明确，特别是捐赠对活体捐赠者长期健康和福祉的影响。尽管目前正在利用国家登记处的数据开发预测DDLT结果的风险因素，但这些登记处目前还没有收集到开发针对活体供体和LDLT受体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A2ALL队列中收集了关于供体和受者特征的数据，但需要制定更多的工具，包括适当的措施，以充分描述与长期健康状况和患者报告的结果（包括福祉）有关的风险。最后，对于移植，特别是LDLT中涉及的复杂医疗保健过程，调节和缓和风险因素对结果的影响的知识和标准缺乏。了解LDLT流程和风险因素尤其重要，因为加强与患者安全（例如，临床医生与临床医生之间的沟通、护理协调）和临床医生与患者之间的沟通（例如，信息交流、知情同意）相关的医疗保健流程改善了其他医疗保健领域的健康结果。因此，显然有必要通过探索特定风险因素的影响和医疗保健过程介质对长期健康和福祉的结果域的影响来扩大LDLT的研究。

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.