OBJECTIVE To report experience in adult-to-adult living donor liver transplantation for acute liver failure using extended right lobe graft. METHODS A 42-year-old male with acute liver failure received adult-to-adult living donor liver transplantation using extended right lobe graft. Volumetric analysis with computed tomography (CT) revealed that the volume of donor's extended right liver with medial hepatic vein (MHV) amounted to approximately 1.3% of the recipient's body weight. The donor hepatic vein and recipient inferior vena cava were reconstructed and then anastomosed end to side. The portal veins, hepatic arteries and bile ducts were anastomosed end-to-end, respectively. RESULTS The operations in donor and recipient were all successful. The donor recovered uneventfully. The recipient regained consciousness in 8 hours and got normal liver function 14 days after transplantation. On day 16 after transplantation, transaminases such as alanine transaminase, aspartate transaminase increased expeditiously in the recipient and was controlled effectively with methylprednisolone (1000 mg). The recipient and donor has survived for 8 months healthily without vascular and bile duct complications. CONCLUSIONS Adult-to-adult living donor liver transplantation for acute liver failure using extended right lobe graft can achieve superior results when performed by an experienced team in hepatectomy and transplantation. This technique extends the success of living donor liver transplantation and opens a new donor pool for adults to receive a timely graft of adequate function.