The authors investigated a novel application of patient-specific three-dimensional (3D) printing, to enhance preoperative, multidisciplinary planning in complex, living-donor pediatric renal transplantation.
For children with end-stage kidney disease, the transplantation of adult-sized, living-donor kidneys into small recipients (<20 kg) with increasingly complex structural anomalies can be difficult. Establishing the operative feasibility in such cases demands a surgical understanding of anatomy to be derived from medical imaging. However, this is hampered by the representation of complex structures in 2D, the inherent interpretive expertise this demands, and the challenge of conveying this appreciation to others.
We report the novel use of patient-specific 3D printed models to achieve personalized management for 3 children who underwent living-donor renal transplantation. Each presented a unique surgical challenge that would otherwise prevent preoperative determination of transplantation feasibility. Patient-specific geometries were segmented from imaging data and fabricated using polyjet, 3D printing technology. Models were verified by an expert radiologist and presented during multidisciplinary discussion and surgical simulation.
3D printed models enhanced preoperative deliberation and surgical simulation and allowed on-table exploration of a small child to be avoided. We have critically determined specific clinical indications, technical insights, limitations, and outcomes of this approach. At latest follow-up (>16 mo) all patients remain well with functioning renal allografts.
We report the new and safe integration of patient-specific 3D printing into complex pediatric renal transplantation. This technique enhances surgical planning and can inform operative feasibility in those cases which would otherwise be uncertain.
*Department of Transplant Surgery, Guy's and St. Thomas’ NHS Foundation Trust, London, UK
†The MRC Centre for Transplantation, King's College London, London, UK
‡Department of Transplantation Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
§Medical Physics, Guy's and St. Thomas’ NHS Foundation Trust, London, UK
¶School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
||Department of Interventional Radiology, Guy's and St. Thomas’ NHS Foundation Trust, London, UK
**Department of Paediatric Radiology at Evelina London Children's Hospital, Guy's and St. Thomas’ NHS Foundation Trust, London, UK
††Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
‡‡Institute of Child Health, University College London, London, UK.
Reprints: Pankaj Chandak, MRCSEng, Research Fellow, Department of Transplant Surgery, 6th floor Borough Wing, Guy's Hospital, London SE1 9RT. E-mail: email@example.com.
We acknowledge Selina Hurley, Curator of Medicine and the Science Museum for accepting our model of Patient 1 into their collection.
This work was supported by the Guy's and St. Thomas’ Charity, grant code EFT140802.
Mr. P.C. and Mr. N.B. contributed equally to this article.
Reprints will not be available from the authors.
All patients provided written informed consent for all stages of clinical management, including patient-specific 3D printing.
N.M. was funded/supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy's and St Thomas’ NHS Foundation Trust and King's College London. This study was also supported by the National Institute for Health Research Biomedical Research Centres at Great Ormond Street Hospital for Children NHS Foundation Trust and University College London. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health.
The authors report no conflicts of interest.