Living Donor Liver Transplantation Cohort Study

活体肝移植队列研究

• 批准号: 7391878
• 负责人: CARL L. BERG
• 金额: $ 6.75万
• 依托单位: UNIVERSITY OF VIRGINIA
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-09-17 至 2009-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7391878
• 关键词: Acute Liver Failure; Adult; Allografting; Cessation of life; Child; Chronic; Chronic Hepatitis C; Clinical; Clinical Research; Clinical Research Protocols; Cohort Studies; Counseling; Data; Data Collection; Databases; Decision Analysis; Decision Making; Development; Dissection; Drug Formulations; Evaluation; Factor Analysis; Future; Healthcare Systems; Hepatitis C; Hepatitis C virus; Hepatocyte; Heterogeneity; Histologic; Human Resources; Infection; Injury; Institution; Kinetics; Lead; Liver; Liver diseases; Living Donor Liver Transplantation; Living Donors; Medical; Methods; Modeling; Molecular Virology; Natural regeneration; Numbers; Operative Surgical Procedures; Organ; Organ Donor; Outcome; Pathway interactions; Patients; Policies; Population; Procedures; Protocols documentation; Rate; Reporting; Research; Research Personnel; Research Proposals; Role; Serum; Societies; Staging; Standards of Weights and Measures; Techniques; Time; Transplant Recipients; Transplantation; United Network for Organ Sharing; United States; Universities; Viral; Virginia; cohort; cost; cost effectiveness; data modeling; liver transplantation; multidisciplinary; novel strategies; programs; prospective; receptor

As the disparity between number of potential liver transplant recipients and available cadaveric organs has widened, novel approaches have been developed to permit the successful transplantation of the largest possible number of patients with end-stage liver disease. The most promising of these stategies has involved the application of adult to adult living donor liver transplantation (LDLT). More than fifteen U.S. transplant centers have now utilized LDLT as a standard method for liver replacement. Despite the increasingly widespread application of this approach, considerable heterogeneity exists betweencenters regarding donor and recipient evaluation as well as the surgical techniques employed. Moreover, information is lacking regarding outcomes of this procedure for both donor and recipient, no data available to identify donors or recipients who may benefit most (or least) from this procedure, and no data todetermine whether using LDLT is a cost-effectivestrategy. In this setting, we propose to participate as a transplant center (TC) in the LDLT Clinical Research Consortium. In this role, we propose to participate in the development of a prospective comprehensive data base and information core that will permit the dissection of the factors which lead to favorable, or unfavorable, outcomes in LDLT as compared to standardcadaveric tranplantation. The exisiting UVA STRANDS database will permit retrospective collection of data from LDLT and cadaveric transplants performed over the last 5 years. In addition, the TC proposes to build on its institutional strengths to lead two clinical research protocols. The first protocol will develop a Cost Utility Decision Analysis using the Adult to Adult Living Donor Liver Transplantation Cohort. This research will yield a valid decision analysis model that can be used in a general patient population to better define subpopulations that would benefit from LDLT as opposed to cadaveric liver transplant. Costs and utilities to the health care system and the patients involved will be clarified for use in patient counseling, medical decision-making, and policy formulation. The second clinical research proposal will examine the outcomes of LDLT in patients infected with hepatitis C and compare these outcomes to cadaveric controls. Mechanisms that contribute to rapid allograft infection and injury will be examined including hepatocyte infection, rates of viral replication and kinetics of serum viral clearance.

由于潜在的肝移植受体和可用尸体器官之间的差异具有 开发了扩大的新方法，以成功地移植最大的方法 可能的末期肝病患者数量。这些国家最有前途的 涉及将成年活性供体肝移植（LDLT）应用于成人。超过15美国 现在，移植中心已将LDLT用作肝脏置换的标准方法。尽管有 这种方法越来越广泛地应用，存在相当多的异质性 关于捐助者和接受者评估以及所采用的手术技术。而且， 对于捐助者和收件人，缺乏有关此过程结果的信息，没有可用的数据 确定可能从此过程中受益最多（或最少）的捐助者或收件人，并且没有数据确定 是否使用LDLT是一种成本效益。在这种情况下，我们建议作为移植 LDLT临床研究联盟中的中心（TC）。在这个角色中，我们建议参加 开发预期的全面数据库和信息核心，该数据将允许解剖 与StandardCadaveric相比，LDLT导致有利或不利结果的因素 trantantation。 Exisising UVA Strands数据库将允许回顾性收集LDLT的数据 在过去的5年中，尸体移植进行了。此外，TC提议建立在其基础上 机构优势领导两个临床研究方案。第一个协议将开发成本实用程序 使用成人对成人活供体肝移植队列的决策分析。这项研究将产生 一个有效的决策分析模型，可以在普通患者群体中使用，以更好地定义 与尸体肝移植相反，将受益于LDLT的亚群。成本和公用事业 医疗保健系统和涉及的患者将被澄清用于患者咨询，医疗 决策和政策制定。第二项临床研究建议将检查结果 感染丙型肝炎的患者的LDLT的LDLT，并将这些结果与尸体对照进行比较。 将检查导致快速同种异体感染和损伤的机制，包括肝细胞 感染，病毒复制率和血清病毒清除的动力学。