Randomized trial on Extended versus Modified Right Lobe Grafts in Live Donor Liver Transplantation.Varghese CT, Bharathan VK, et al.
Liver transplantation 2018 [record in progress].
To compare the early postoperative outcomes between extended and modified right lobe grafts in recipients and donors of live donor liver transplantation (LDLT).
Participants were randomized to receive either extended right lobe graft where transection plane was maintained to the left of middle heaptic vein (MHV), and division of MHV performed beyond the segment VIII vein, versus modified right lobe graft where transection plane was maintained to the right of MHV, and the segment V and VIII drainage was reconstructed using a conduit of recipient portal vein.
86 liver donors and recipients aged >18 years who underwent right lobe LDLT.
The primary outcome measured was patency of the MHV in the recipient. Secondary measured outcomes included biochemical parameters, postoperative complications, mortality in recipients and donors, and volume regeneration of remnant liver in donors.
This study compared live donor liver techniques from right lobe hepatectomy: (1) extended right lobe grafts (ERG: transection plane was maintained to the left of middle hepatic vein, and division of middle hepatic vein performed beyond the segment VIII vein) and (2) modified right lobe grafts (MRG: transection plane was maintained to the right of middle hepatic vein, the segment V and VIII drainage was reconstructed using a conduit of recipient portal vein. The study excluded grafts with a predominant drainage of segment IV into MHV. The primary outcome was the patency of the middle vein reconstruction in the recipient, and the study was powered as an equivalence trial. One could argue that the study should have been powered to assess safety for the donor. MRG had a lower rate of middle vein patency (albeit not statistically significant in this small trial, 81% versus 91%, p=0.21) and the authors have called this equivalence; an equivalence margin of 25% was used in the power calculation. The volume regeneration was significantly better with MRG.
Clinical Trials Registry of India - CTRI/2016/08/007186