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UNC among 10 U.S. medical centers tapped
to study living donor liver transplants

The National Institutes of Health has designated the University of North Carolina at Chapel Hill one of 10 medical centers nationwide to participate in the Adult to Adult Living Donor Liver Transplant Cohort Study.

The seven-year project will investigate the experience of patients eligible for living donor liver transplantation, focusing on factors influencing outcomes for donors and recipients. Researchers will compare outcomes of this procedure with those for patients who receive livers from cadavers.

Because of the shortage of donor livers, many patients with liver disease die while awaiting an organ for transplantation. In 2001, about 17,000 patients waited for donated livers, but only 4,673 cadeveric organs were actually donated that year.

"Liver transplantation is the only definitive therapy for end-stage liver disease. Due to the huge discrepancy between the number of cadaveric organs available for standard transplantation and patient need, centers around the world are trying to expand the donor pool by using livers from live donors. UNC has been a pioneer in this effort," said Dr. Roshan Shrestha, associate professor of medicine at the School of Medicine and medical director of the liver transplantation program. Shrestha is also principal investigator of the UNC study site.

In living donor liver transplants, a living healthy donor, usually a relative of the patient, donates a section of liver to the recipient. The liver is a large segmented organ that can potentially be split without harm to the donor and with benefit to the recipient. Unlike most organs, the liver can regenerate itself. The donorís remaining liver grows to its original size within weeks. Likewise, the donated lobe will also grow in the recipientís body.

For children in need of liver transplantation, the success of living donor transplantation from an adult made it an accepted medical option. Adults in need of liver transplantation require a larger segment, as much as half or more of the donorís liver. This requires a more extensive and complex surgery, with potentially greater risks for donor and recipient.

The procedure has evolved so rapidly that more than half of living donor transplants performed to date have occurred since 2000, according to the National Institute of Diabetes & Digestive & Kidney Diseases. Evaluation of donors and surgical procedures varies from one transplant center to another. The institute has pointed out that although the large majority of living donor liver transplants have been successful, data are few to inform potential donors about risks. Post-surgical problems for donors can include infection, pneumonia and leaking bile, which can require further surgery.

"Among many important questions this multi-center study will explore, UNC proposes we study drug metabolism in the regenerating livers of donors and recipients. We are also proposing studies on short- and long-term outcomes for donors following donation surgery for living donor liver transplantation," Shrestha said.

UNC began its live donor liver transplant program in October 1996. Today, the UNC Center for Liver Diseases and Transplantation provides highly specialized care for liver diseases for residents of North Carolina and surrounding regions. In addition to its commitment to patient care, the UNC liver program is dedicated to studying novel therapies for viral hepatitis, other chronic liver diseases and transplantation.

"Itís gratifying that living donor liver transplantation is a priority issue for NIH, one that requires answers to important questions on benefits and risks," said Dr. Jeffrey H. Fair, director of abdominal transplantation at UNC and co-principal investigator. "Our transplant program at UNC has been among the leaders in the field and will continue to evolve and change as the field evolves. We are very honored to be a part of this new study."

Along with UNC, participating medical centers include the University of California at Los Angeles, the University of California at San Francisco, the University of Colorado at Denver, Northwestern University, Columbia University, the University of Pennsylvania, the University of Virginia, Virginia Commonwealth University and the University of Michigan.

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