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 strategies 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 between centers 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 to determine whether using LDLT is a cost-effective strategy. 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 standard cadaveric transplantation. The existing 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.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Research Project--Cooperative Agreements (U01)
Project #
Application #
Study Section
Special Emphasis Panel (ZDK1-GRB-D (M1))
Program Officer
Everhart, James
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Virginia
Internal Medicine/Medicine
Schools of Medicine
United States
Zip Code
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
Samstein, B; Smith, A R; Freise, C E et al. (2016) Complications and Their Resolution in Recipients of Deceased and Living Donor Liver Transplants: Findings From the A2ALL Cohort Study. Am J Transplant 16:594-602
Levitsky, J; Kaneku, H; Jie, C et al. (2016) Donor-Specific HLA Antibodies in Living Versus Deceased Donor Liver Transplant Recipients. Am J Transplant 16:2437-44
Gordon, Fredric D; Goldberg, David S; Goodrich, Nathan P et al. (2016) Recurrent primary sclerosing cholangitis in the Adult-to-Adult Living Donor Liver Transplantation Cohort Study: Comparison of risk factors between living and deceased donor recipients. Liver Transpl 22:1214-22
Pomposelli, James J; Goodrich, Nathan P; Emond, Jean C et al. (2016) Patterns of Early Allograft Dysfunction in Adult Live Donor Liver Transplantation: The A2ALL Experience. Transplantation 100:1490-9
Emond, Jean C; Fisher, Robert A; Everson, Gregory et al. (2015) Changes in liver and spleen volumes after living liver donation: a report from the Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL). Liver Transpl 21:151-61
Ladner, Daniela P; Dew, Mary Amanda; Forney, Sarah et al. (2015) Long-term quality of life after liver donation in the adult to adult living donor liver transplantation cohort study (A2ALL). J Hepatol 62:346-53
Olthoff, Kim M; Emond, Jean C; Shearon, Tempie H et al. (2015) Liver regeneration after living donor transplantation: adult-to-adult living donor liver transplantation cohort study. Liver Transpl 21:79-88

Showing the most recent 10 out of 36 publications