Comparison of modified extended right lobe graft versus modified right lobe graft in adult living donor liver transplantation: Experience from Pakistan

Objectives: To compare the outcomes of modified extended right lobe graft (MERLG) and modified right lobe graft (MRLG) in living-donor liver transplantation (LDLT). Methods: This retrospective study was performed at the Liver transplant department of the Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences Hospital, Gambat, Pakistan, from March 2019 to September 2020. The outcomes of 20 MERLG donors and recipients were compared to those of 74 MRLG donors and recipients. Demographics, operative parameters, complications, hospital stay, and one-year survival were compared between the two groups. Results: The mean graft volume of the MERLG group was more (637.10 +/- 71.35 g) than in the MRLG group (562.27 +/- 57.77 g), (p= 0.001). Donor blood loss was higher in the MERLG group (680.10 +/- 170.60 ml) compared to the MRLG group (650.23 +/- 190.65 ml), p=0.527. In addition, the operative time was longer in the MERLG group (345.80 +/- 76.90 min) than in the MRLG group (318.12 +/- 100.80 min) (p= 0.257). The MERLG recipients were sicker (mean MELD score of 22.54 +/- 3.67) than the MRLG (18.86 +/- 4.37) (p=0.001). The drain output was higher in the MRLG group (1340 +/- 470.32 ml) than in the MERLG group (1110 +/- 450.60 ml) (P =0.045). No significant difference was found when comparing postoperative laboratory results and complications between the donor and recipient groups (p >0.05). Kaplan-Meier analysis showed a 95% one-year survival in MERLG group compared to 90.7% in the MRLG group (p=0.549). Conclusion: With appropriate technical expertise, MERLGs are technically safe and feasible in LDLT donors without any added risks. MERLGs also yielded better outcomes in sick recipients.