Purpose:
There are two principal purposes of this study: 1) to determine whether it is more beneficial
for a liver transplant recipient candidate to pursue a living donor liver transplant (LDLT)
or wait for a deceased donor liver transplant (DDLT), and 2) to study the impact of liver
donation on the donor's health and quality of life.
Study summary:
Adult to adult living donor liver transplantation (LDLT) is a relatively new procedure
increasingly used at major transplantation centers. Relatively small numbers of cases are
performed at any one center and approaches to the patient and donor are too diverse across
centers to provide reliable and generalizable information on donor and recipient outcomes
from individual centers. Therefore, a network of nine leading liver transplantation centers
and a data coordination center (DCC) has been organized to accrue and follow sufficient
numbers of patients being considered for and undergoing LDLT to provide generalizable results
from adequately powered studies. This network has established the Adult to Adult Living Donor
Liver Transplantation Cohort Study (A2ALL) that will conduct both retrospective and
prospective studies of LDLT.
The primary study objective is to analyze the effect of choosing to pursue living liver
donation. The principal hypothesis is that pursuit of a living liver allograft leads to
decreased pre-transplant morbidity and mortality and better long term outcomes for patients
starting from the point at which listed patients have a potential donor evaluated (at least a
history and physical examination). Emerging data suggest that LDLT provides an inferior graft
because of reduced parenchymal mass and added technical complexity when compared to a whole
liver used for DDLT. The magnitude of the disadvantage to the LDLT graft will be assessed by
comparing results between LDLT and DDLT from the time of transplant. Finally, a careful and
detailed series of studies of potential and actual living liver donors is included as a
primary objective because of the tremendous importance of this issue to our understanding of
the impact of the procedure.
Secondary objectives will address selected biological and clinical issues in transplantation
structured around the comparison between DDLT and LDLT.
Criteria:
Inclusion Criteria - Potential Recipients:
- Potential recipient listed for single organ (liver) transplantation
- Patient is eligible for LDLT
- Age ≥ 18 years old at the time of donor history and physical exam
- Indication for transplant: non-fulminant liver disease
- Potential donor scheduled for evaluation (history and physical examination) within
four weeks
Inclusion Criteria - Potential Donors:
- Meet donor criteria of the transplant center
- Age >= 18 years old at donation
- Be evaluated with a history and physical examination at the transplant center
- Potential donor's recipient listed for single organ (liver) transplantation