Trial Information

Adult-to-Adult Living Donor Liver Transplantation Cohort Study

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.