Cost-effective and Time-saving Three-Dimensional (3-D) Printing Protocol of Intra-abdominal Cavity of Liver Transplantation Recipient to Minimize Risk of Large-for-Size Syndrome: The Initial Experience

Abstract

Introduction: The application of 3-D printing has been increasing and we invented a protocol for a cost-effective and time-saving 3-D model of intra-abdominal cavity to prevent large-for-size syndrome during liver transplantation. Methods: 3-D printing of the intra-abdominal cavity were performed on adult recipients with small cavity and pediatric patients scheduled for transplantation between July 2020 to July 2021. To reduce time and cost, boundaries of intra-abdominal cavity were outlined based on computed tomography of the recipient with a 1 to 3cm distances. The printed models of adult patients were used for comparing the size to the graft during deceased donor operation while models of pediatric patients were used for directly comparing the size to the 3-D printed graft of living donors. Results: Median time for model production was 10.8 hours (IQR 9.5–11.8) and estimated median cost for the filament used was 1.64 dollars (IQR 1.50–1.74). Transplantation of reduction graft (n=1), whole liver transplantation after giving up the previous donor match (n=2), and waiting for another donor match after giving up first matched donor (n=1) were resulted using 3-D printed model in adult patients. Among pediatric patients, two cases were resulted in reduction graft as planned during preoperative planning and three cases resulted in extended left lateral graft transplantation. All the cases ended up with successful closure of the abdomen with no large-for-size syndrome. Conclusion: Our cost-effective and time-saving 3-D printed model was proved to be useful for preventing large-for-size syndrome in small adult recipients and pediatric patients.