A2ALL Cohort Study: Pyschosocial and Surgical Outcomes

A2ALL 队列研究：心理社会和手术结果

• 批准号: 8725866
• 负责人: ABHINAV HUMAR
• 金额: $ 15.15万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2016-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8725866
• 关键词: Adult; Anxiety Disorders; Area; Characteristics; Clinical; Cohort Studies; Collaborations; Country; Data; Data Analyses; Data Coordinating Center; Data Quality; Databases; Development; Disability Insurance; Employment; Enrollment; Family member; Fatigue; Functional disorder; Generic Drugs; Genes; Genomics; Goals; Health; Health Insurance; Injury; Insurance Benefits; Intervention; Life Insurance; Ligation; Liver; Liver Function Tests; Liver Regeneration; Living Donor Liver Transplantation; Living Donors; Long-Term Effects; Manuscripts; Measurement; Measures; Mental Health; Methods; Modification; Mood Disorders; Motivation; Natural regeneration; Operative Surgical Procedures; Outcome; Patients; Pattern; Perfusion; Personal Satisfaction; Portal Pressure; Preparation; Prevalence; Procedures; Protocols documentation; Quality of life; Randomized; Recovery; Relative (related person); Reperfusion Therapy; Research; Risk; Risk Factors; Role; Structure of splenic artery; Symptoms; Syndrome; Techniques; Time; Transplantation; Universities; comparison group; design; experience; follow-up; health related quality of life; hepatic sinusoid; improved; innovation; insight; liver transplantation; prevent; psychosocial; success; transplant database

DESCRIPTION (provided by applicant): Our understanding of ALDLT has advanced significantly since the initial establishment of the A2ALL consortium; however, several important research issues and clinical questions regarding ALDLT remain unanswered. These include fundamental questions regarding the impact of this procedure on the long-term health and well-being of living donors, especially beyond the 1st year postdonation. With regards to recipient outcomes, the technical surgical problems associated with the procedure remain of paramount importance and the surgical limitations of this procedure, as well as methods to overcome these problems, are poorly defined. Our overall goals are to study the short- and long-term effects of ALDLT on the donor and recipient and to gain insight into unique donor and recipient issues through study of this innovative procedure, which will be achieved by full participation in the A2ALL consortium in collaboration with other transplant centers and the data coordinating center. With regards to long- term donor follow up, our aim is to advance beyond generic measures of QOL already included in A2ALL and determine (a) the prevalence and temporal patterns of psychiatric symptomatology and diagnosable mood and anxiety disorders in the extended years following donation; (b) the level of enduring fatigue, other somatic symptoms, and lasting health concerns in the extended years post-donation; and (c) identify the long term financial consequences for donors including health-related financial expenses, changes in employment, and changes in health, disability, or life insurance benefits. Finally, with regards to specific technical issues related to the recipient surgery, our aim is to study the specific risk factors involved in the development of small-for-size-syndrome (SFSS) in recipients after ALDLT - most specifically the impact of portal pressure measurements and inflow modification on the risk for SFSS. Our hypothesisis is that SFSS likely represents a portal hyperperfusion injury to the hepatic sinusoids and measurements of portal pressures and portal flow likely represents the best predictor for SFSS. A randomized study is proposed to look at the impact of inflow modification (specifically splenic artery ligation) vs. no intervention on liver regeneration and risk for developing SFSS in recipients identified to have elevated portal pressure post reperfusion of the liver graft.

描述（由申请人提供）：自A2All财团的初始建立以来，我们对ALDLT的理解已大大提高；但是，有关ALDLT的一些重要研究问题和临床问题仍未得到答复。其中包括有关该程序对生活捐助者长期健康和福祉的影响，尤其是在奉献后第一年之外的基本问题。关于接受者的结果，与该过程相关的技术外科手术问题仍然至关重要，并且该程序的手术局限性以及克服这些问题的方法的定义很差。我们的总体目标是研究ALDLT对捐助者和接受者的短期和长期影响，并通过研究这种创新程序来深入了解独特的捐助者和接受者问题，这将通过与其他移植中心以及数据协调中心的其他合作来实现A2All财团来实现。关于长期捐助者的随访，我们的目的是超越A2ALL已包含的QOL的通用度量，并确定（a）捐赠后的延长几年，精神病症状学以及可诊断的情绪和焦虑症的患病率和时间模式； （b）持续的疲劳，其他体细胞症状和持久的健康问题的水平； （c）确定捐助者的长期财务后果，包括与健康相关的财务费用，就业变化以及健康，残疾或人寿保险福利的变化。最后，关于与接受者手术有关的特定技术问题，我们的目的是研究ALDLT后接受者中小型综合剂（SFS）涉及的特定风险因素 - 最具体地说，是门户压力测量和流入对SFS风险的影响的影响。我们的假设是，SFSS可能代表了肝正正弦体的门户高灌注损伤，门户压力和门户流量的测量可能代表了SFSS的最佳预测指标。提出了一项随机研究来研究流入修饰（特别是脾动脉连接）的影响，而没有干预对肝脏再生的干预和在肝脏移植后再灌注后升高的接受者中发展SFS的风险。