<p>Despite advances in the practice of live donor liver transplantation (LDLT), the optimum surgical approach with respect to the middle hepatic vein (MHV) in right lobe LDLT remains undefined. We designed a randomized trial to compare the early postoperative outcomes in recipients and donors between extended right lobe grafts (ERG: transection plane was maintained to the left of MHV, and division of MHV performed beyond the segment VIII vein) and modified right lobe grafts (MRG: transection plane was maintained to the right of MHV, the segment V and VIII drainage was reconstructed using a conduit of recipient portal vein).Eligible patients(n=86)were prospectively randomized into ERG arm (n=43) and MRG arm(n=43) at the beginning of donor hepatectomy. The primary end point considered in this equivalence trial was patency of the MHV or the reconstructed "neo-MHV" in the recipient. The secondary end points included biochemical parameters, postoperative complications, mortality in recipients as well asdonorsand volume regeneration of remnant liver in donors, measured at 2 months. The patency of MHV was comparable in the ERG and MRG arms (90.7% vs 81.4%, Difference: 9.3%, 95% CI: -5.8 to 24.4, Z score: 1.245, p = 0.21). Volume regeneration of the remnant liver in donors was significantly better in the MRG arm (111.3% vs 87.3%, mean difference: 24%, 95% CI: 14.6 to 33.3, p<0.001). The remaining secondary end points in donors and recipients were similar between the two arms. To conclude, MRG with reconstructed neo-MHV has comparable patency to native MHV in ERG, and confers equivalent graft outflow in the recipient. Furthermore, it allows better remnant liver regeneration in the donor at two months. This article is protected by copyright. All rights reserved.</p>
C. Titus Varghese, Bharathan, V. Kumar, Gopalakrishnan, U., Balakrishnan, D., Menon, R. N., Sudheer, O. Vayoth, Dhar, P., and Surendran, S., “Randomized trial on Extended versus Modified Right Lobe Grafts in Live Donor Liver Transplantation.”, Liver Transpl, 2018.