The A2ALL consortium was chartered in 2002 and has collected data on a large cohort of donor and recipient candidates for LDLT spanning over a decade of activity in 9 US centers. Dr. Emond has been a Co-chair of A2ALL and a member of the Project Executive Committee since the onset of the study and led the development of the cohort protocol. The consortium has contributed important publications defining the benefit of choosing living donation, and the outcomes and complications of the donor and recipient procedure. Descriptive studies from the retrospective cohort have defined the donor evaluation, and illuminated important issues on hepatitis C, HCC, and rejection in recipients of LDLT. A2ALL remains positioned to address critical biological questions related to hepatic inflammation, regeneration, and carcinogenesis in the recipient. A novel and important interventional trial of pre-transplant treatment of HCV in LDLT candidates is underway. Equally important is to study donor liver function and regeneration as well as to define the long-term medical and psychological consequences of liver donation. Columbia has contributed substantially to the overall accrual of A2ALL includes 239 subjects in retro, 17 subjects in bridge and 270 in A2ALL cohort. Clinical outcomes are excellent with a one year recipient survival of 95.3% of adults. In this application for renewal, we commit to continued follow-up of our donors and recipients and further accrual of subjects to achieve the goals of the consortium as defined in the RFA. We describe numerous organizational and technologic improvements in our center, including dedicated staff and an electronic record system to optimize data collection and follow-up. Though A2ALL has made great progress in description of LDLT and defining the outcomes, we have fallen short in two critical areas, understanding of the donor experience and development of surgical innovations to reduce the donor operation without compromising recipient outcomes. These related issues are central to making the case for expansion of LDLT in adults. No matter how good the results of LDLT, there will be no impact if it is not used. To this end we introduce two research proposals that are complementary and enhance the overall aims of A2ALL. First, a structured study of the psychiatric complications in living donors including developing predictors and determining using a control population of concurrently enrolled laparoscopic renal donors whether more limited hepatectomy will improve psychological health of donors. Second, a pilot protocol of using smaller left lobe grafts with appropriate biological and technical manipulations

Public Health Relevance

There remains a major shortage of donors for the nearly 16000 patients waiting for liver transplantation (OLT). Living donor liver transplantation (LDLT) has offered an alternative source of organs but was used in only 178 of 5705 adults (3.1%) receiving OLT in the US in 2008. We propose to increase the use of LDLT by interventions which decrease the extent of the donor hepatectomy, increasing donor safety

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Research Project--Cooperative Agreements (U01)
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Study Section
Special Emphasis Panel (ZDK1-GRB-8 (O2))
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Sherker, Averell H
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Columbia University (N.Y.)
Schools of Medicine
New York
United States
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Dew, Mary Amanda; Butt, Zeeshan; Liu, Qian et al. (2018) Prevalence and Predictors of Patient-Reported Long-term Mental and Physical Health After Donation in the Adult-to-Adult Living-Donor Liver Transplantation Cohort Study. Transplantation 102:105-118
Butt, Zeeshan; DiMartini, Andrea F; Liu, Qian et al. (2018) Fatigue, Pain, and Other Physical Symptoms of Living Liver Donors in the Adult-to-Adult Living Donor Liver Transplantation Cohort Study. Liver Transpl 24:1221-1232
Butt, Z; Dew, M A; Liu, Q et al. (2017) Psychological Outcomes of Living Liver Donors From a Multicenter Prospective Study: Results From the Adult-to-Adult Living Donor Liver Transplantation Cohort Study2 (A2ALL-2). Am J Transplant 17:1267-1277
Levitsky, Josh; Goldberg, David; Smith, Abigail R et al. (2017) Acute Rejection Increases Risk of Graft Failure and Death in Recent Liver Transplant Recipients. Clin Gastroenterol Hepatol 15:584-593.e2
DiMartini, A; Dew, M A; Liu, Q et al. (2017) Social and Financial Outcomes of Living Liver Donation: A Prospective Investigation Within the Adult-to-Adult Living Donor Liver Transplantation Cohort Study 2 (A2ALL-2). Am J Transplant 17:1081-1096
Baker, Talia B; Zimmerman, Michael A; Goodrich, Nathan P et al. (2017) Biliary reconstructive techniques and associated anatomic variants in adult living donor liver transplantations: The adult-to-adult living donor liver transplantation cohort study experience. Liver Transpl 23:1519-1530
Emond, Jean C; Goodrich, Nathan P; Pomposelli, James J et al. (2017) Hepatic Hemodynamics and Portal Flow Modulation: The A2ALL Experience. Transplantation 101:2375-2384
Mandell, M Susan; Smith, Abigail R; Dew, Mary Amanda et al. (2016) Early Postoperative Pain and its Predictors in the Adult to Adult Living Donor Liver Transplantation Cohort Study. Transplantation 100:2362-2371
Dew, Mary Amanda; DiMartini, Andrea F; Ladner, Daniela P et al. (2016) Psychosocial Outcomes 3 to 10 Years After Donation in the Adult to Adult Living Donor Liver Transplantation Cohort Study. Transplantation 100:1257-69
Wolf, Joshua H; Holmes, Michael V; Fouraschen, Suomi et al. (2016) Serum lipid expression correlates with function and regeneration following living donor liver transplantation. Liver Transpl 22:103-10

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