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Objective: Using non-invasive methods, such as BMI and CT LAIto suggest a prediction model for hepatic steatosis, examine the CT liver attenuation index and body mass index (BMI)association for pathological steatosis in living liver donors. Histological analysis remains the standard reference. Study Design: Retrospective study Place and Duration of Study: Liver Transplantation Department, Bahria International Hospital Orchard, Lahore from 1st June 2017 to 31st December 2018. Methodology: Fifty-nine donors were included with a median age of 23.00 years, as well as the potential donors for LDLT who experienced evaluation as a potential liver donor. Donors who underwent CT scan and histological liver evaluation were part of this study. Results: Of the donors, forty-eight (81.35%) had a CT LAI ≥1. The median BMI was 22.1 (range: 17.00–33.4). Twenty eight (47.5%) of the patients had undergone liver biopsy for screening in the pre-transplant period whereas 31 (52.5%) of the total evaluated donors underwent biopsy during the transplant. Thirty four (57.62%) out of 59 evaluated living liver donors underwent hepatectomy. Non-significant association (P=0.719) between different categories of BMI as the steatosis increases histologically, whereas significant association (P<.05) for CT LAI as the steatosis increases histologically. Conclusion: Body mass index alone is not a reliable factor for liver fat estimation non-enhanced CT liver-spleen attenuation index of ≤0 correspond to severe hepatic steatosis reserving histopathological liver evaluation via biopsy for selected cases and decreasing the need of liver biopsy while making sure both donor and recipient are safe. Keywords:Living donor liver transplantation, CT LAI, BMI, Liver biopsy

Background: Liver transplantation is a complicated surgical procedure that involves many complexities such as bleeding and the risk of transfusing blood components. Aim: To investigate the effect of the Rotational Thormboelastometry (ROTEM) algorithm-based blood or blood product transfusion, in clinical outcome of living donor liver transplant (LDLT) patients. Study design: Retrospective study Place and duration of the study: Bahria Town international hospital Lahore from 1st January 2016 to 31st December 2020. Methodology: Sixty patients of living donor liver transplant were enrolled. They were then divided into two groups as per the approved transfusion protocol. The first group named pre-ROTEM and the second was ROTEM group. Initial biochemical features, blood transfusion and patient outcomes were documented. Results: The need for large-scale blood transfusion and transfusion-related products were statistically less in ROTEM group as compared to the pre-ROTEM group. Conclusion: The ROTEM-based algorithms can be used effectively to reduce transfusion of blood components and may increase the chances of early transplant functioning. Keywords: ROTEM algorithm, Blood transfusion, Liver transplant, ASA guideline, Thromboelastogram, TEG

Aims & Objectives: Corner stone in performing living donor liver transplant is to assess and predict the adequacy of the donated liver for recipient and remaining liver. Previously the conversion of liver volume to estimated weight is done by using unit to unit conversion with a factor of 1. We analyzed data of our institute to research the methodology and local applicability of the same. Place and duration of study: Shaikh Zayed Hospital, Lahore. January 2011 to June 2017 Material & Methods: Retrospective data was collected for the first 115 recipients and donors. Their preoperative liver volumes calculated by C.T scan and post-operative graft harvested with weights were compared. Results: The parameter of actual volume of right lobe averaged to 769.77 ± 12.73 gm varying with a quantum of 17.73% (426 – 1123 gm). Estimated volume of right lobe of liver varied 358 to 1218 ml (CV = 17.84%) with an average value of 798.96 ± 13.29 ml. Results of linear regression between estimated volume of right lobe and actual weight of the right lobe in gm was significantly linear (r = 0.830, r2 = 0.690, adj. r2 = 0.689 and F = 250.98, p < 0.0001), showing that volumetric assessment overestimated graft weight/volume. Following is equation generated from our data for graft weight estimation. Actual right lobe (g) = 134.004 + 0.796 (estimated right lobe volume (ml) ± 76.42. Conclusion: Using one to one principle for volume estimation of healthy liver can be misleading and therefore we propose an equation to reach more accurate estimation of graft weight. Keywords: living donor liver transplant, CT volumetry, graft to body weight ratio