Application of 3‐Dimensional Printing in Pediatric Living Donor Liver Transplantation: A Single‐Center Experience

Abstract

Three‐dimensional (3D) printing has been used to support organ transplantations. However, whether it helps remains unclear. This study aimed to present and assess the application of 3D‐printed liver models in pediatric living donor liver transplantation (LDLT). The 3D images were printed to touchable liver models with transparent liver parenchyma, specifically colored hepatic vessels, and biliary structures. A total of 30 consecutive recipients were enrolled in the study: 10 were operated on with the support of 3D printing (3D‐printing group) and 20 (control group) were operated on without it. Detailed photographs and data of the cases in the 3D‐printing group were presented. One patient underwent auxiliary partial orthotopic liver transplantation using the left lobe graft, in which the abdominal cavity model was also printed to test whether the planned graft fit the recipient’s abdominal cavity. The 3D‐printed models facilitated surgical planning and procedures, particularly in the management of hepatic veins and in the prevention of large‐for‐size syndrome. The operative time of donors in the 3D‐printing group was significantly shorter compared with the control group (2.3 ± 0.4 versus 3.0 ± 0.4 hours; P < 0.001). Inpatient costs for donors in the 3D‐printing group were 17.1% lower than those in the control group (34.6 ± 6.6 versus 41.7 ± 10.4 thousand ¥; P = 0.03). In conclusion, in small infants and complicated pediatric LDLT patients, 3D‐printed models can help minimize the risk of large‐for‐size syndrome and graft reduction. The 3D‐printed models may be conducive to liver graft procurement and intraoperative assistance in pediatric LDLT.

Consensus recommendations of three-dimensional visualization for diagnosis and management of liver diseases

“…In LDLT for infants or neonates with a limited abdominal space, it is often necessary to reduce the volume of the graft in a complex manner to maintain the necessary vascular structures. Surgeons can simulate donor surgery through 3D images and 3D printed physical models; moreover, the 3D printed model provides a realistic sense of the size, vascular anatomy, and thickness of the reduced graft [52,78,82].…”

Preoperative planning in paediatric liver tumour surgery - a literature review

“…Zhao et al [59] Evaluation study Evaluation of a computer-assisted surgery system in preoperative surgical planning and intraoperative navigation…”

“…Janek et al [58] Blood loss, blood transfusion, recurrence, bilirubin levels, the volume of post-resection liver residue Zhao et al [59] Operation time, blood loss, blood transfusion Wang et al [60] Operation time, blood loss, mortality, intra-and postoperative complications, inpatient stay, cost Esaki et al [61] Liver and spleen volume measurement Ishii et al [63] Operation time, blood loss, intraoperative complications…”

Seeing Both the Forest and the Trees: Where Does 3‐Dimensional Printing Fit in Pediatric Living Donor Liver Transplantation?

“…The acceleration in LDLT experience in Asian countries was born out of necessity, but it has also been catalyzed by a concentration of volume and expertise, technical developments, and innovative approaches . In this issue of Liver Transplantation , Wang et al present their experience with 3‐dimensional (3D) printing of transparent liver models, and they compare outcomes with standard preoperative planning in a series of 30 children undergoing pediatric LDLT.…”

“…Wang et al found 3D printing to be useful in surgical planning especially in the management of hepatic venous anatomic variations, calculations of graft and recipient weights, and determination of spatial orientation and capacity in the abdominal cavity. Of the 10 grafts that used 3D printing, 3 were considered more complex (left lobe, reduced right lobe without the middle hepatic vein, and auxiliary partial orthotopic liver transplantation with a left lobe graft) than the 7 left lateral segment grafts.…”