Ann Hepatobiliary Pancreat Surg.  2025 Feb;29(1):21-31. 10.14701/ahbps.24-153.

Improved graft survival by using three-dimensional printing of intra-abdominal cavity to prevent large-for-size syndrome in liver transplantation

• Park S
• Choi GS
• Kim JM
• Lee S
• Joh JW
• Rhu J

• KMID: 2565403
• DOI: http://doi.org/10.14701/ahbps.24-153

Abstract

Backgrounds/Aims
While large-for-size syndrome is uncommon in liver transplantation (LT), it can result in fatal outcome. To prevent such fatality, we manufactured 3D-printed intra-abdominal cavity replicas to provide intuitive understanding of the sizes of the graft and the patient’s abdomen in patients with small body size between July 2020 and February 2022.
Methods
Clinical outcomes were compared between patients using our 3D model during LT, and patients who underwent LT without 3D model by using 1 : 5 ratio propensity score-matched analysis.
Results
After matching, a total of 20 patients using 3D-printed abdominal cavity model and 100 patients of the control group were included in this study. There were no significant differences in 30-day postoperative complication (50.0% vs. 64.0%, p = 0.356) and the incidence of large-for-size syndrome (0% vs. 7%, p = 0.599). Overall survival of the 3D-printed group was similar to that of the control group (p = 0.665), but graft survival was significantly superior in the 3D-printed group, compared to the control group (p = 0.034).
Conclusions
Since it showed better graft survival, as well as low cost and short production time, our 3D-printing protocol can be a feasible option for patients with small abdominal cavity to prevent large-for-size syndrome after LT.

Keyword

3D-printing; Liver transplantation; Graft survival; Donor selection

Figure

• 

  Fig. 1 The workflow of manufacturing the 3D-printed abdominal cavity model and its application in both deceased donor liver transplantation and living donor liver transplantation.

• 

  Fig. 2 The actual application of the 3D-printed model during (A) deceased donor liver transplantation, (B) living donor liver transplantation, and (C) deceased donor liver transplantation of other institution. GRWR, graft–recipient weight ratio.

• 

  Fig. 3 Graft survival (A) and overall survival (B), between the 3D-printed group and the control group after propensity score matching.

• 

  Fig. 4 Total manufacturing time according to (A) only cases (n = 20) included in the study, and (B) all the manufactured cases (n = 29), including non-operated cases.

Reference

References

1. European Association for the Study of the Liver. 2016; EASL Clinical Practice Guidelines: Liver transplantation. J Hepatol. 64:433–485. DOI: 10.1016/j.jhep.2015.10.006. PMID: 26597456.

2. Fukazawa K, Nishida S. 2016; Size mismatch in liver transplantation. J Hepatobiliary Pancreat Sci. 23:457–466. DOI: 10.1002/jhbp.371. PMID: 27474079.

3. Urata K, Kawasaki S, Matsunami H, Hashikura Y, Ikegami T, Ishizone S, et al. 1995; Calculation of child and adult standard liver volume for liver transplantation. Hepatology. 21:1317–1321. DOI: 10.1002/hep.1840210515. PMID: 7737637.

4. Kiuchi T, Kasahara M, Uryuhara K, Inomata Y, Uemoto S, Asonuma K, et al. 1999; Impact of graft size mismatching on graft prognosis in liver transplantation from living donors. Transplantation. 67:321–327. DOI: 10.1097/00007890-199901270-00024. PMID: 10075602.

5. Rangel Moreira Dde A, Aoun Tannuri AC, Belon AR, Mendonça Coelho MC, Oliveira Gonçalves J, Serafini S, et al. 2014; Large-for-size liver transplantation: a flowmetry study in pigs. J Surg Res. 189:313–320. DOI: 10.1016/j.jss.2014.03.018. PMID: 24721605.

6. Marro A, Bandukwala T, Mak W. 2016; Three-dimensional printing and medical imaging: a review of the methods and applications. Curr Probl Diagn Radiol. 45:2–9. DOI: 10.1067/j.cpradiol.2015.07.009. PMID: 26298798.

7. Muguruza Blanco A, Krauel L, Fenollosa Artés F. 2019; Development of a patients-specific 3D-printed preoperative planning and training tool, with functionalized internal surfaces, for complex oncologic cases. Rapid Prototyp J. 25:363–377. DOI: 10.1108/RPJ-03-2018-0063.

8. Madurska MJ, Poyade M, Eason D, Rea P, Watson AJ. 2017; Development of a patient-specific 3D-printed liver model for preoperative planning. Surg Innov. 24:145–150. DOI: 10.1177/1553350616689414. PMID: 28134003.

9. Zein NN, Hanouneh IA, Bishop PD, Samaan M, Eghtesad B, Quintini C, et al. 2013; Three-dimensional print of a liver for preoperative planning in living donor liver transplantation. Liver Transpl. 19:1304–1310. DOI: 10.1002/lt.23729. PMID: 23959637.

10. Park S, Choi GS, Kim JM, Lee S, Joh JW, Rhu J. 2022; 3D printing model of abdominal cavity of liver transplantation recipient to prevent large-for-size syndrome. Int J Bioprint. 8:609. DOI: 10.18063/ijb.v8i4.609. PMID: 36404778. PMCID: PMC9668574.

11. Fukazawa K, Nishida S, Pretto EA Jr, Vater Y, Reyes JD. 2016; Detrimental graft survival of size-mismatched graft for high model for end-stage liver disease recipients in liver transplantation. J Hepatobiliary Pancreat Sci. 23:406–413. DOI: 10.1002/jhbp.355. PMID: 27108389.

12. Addeo P, Noblet V, Naegel B, Bachellier P. 2020; Large-for-size orthotopic liver transplantation: a systematic review of definitions, outcomes, and solutions. J Gastrointest Surg. 24:1192–1200. DOI: 10.1007/s11605-019-04505-5. PMID: 31919740.

13. Allard MA, Lopes F, Frosio F, Golse N, Sa Cunha A, Cherqui D, et al. 2017; Extreme large-for-size syndrome after adult liver transplantation: A model for predicting a potentially lethal complication. Liver Transpl. 23:1294–1304. DOI: 10.1002/lt.24835. PMID: 28779555.

14. Marconi S, Pugliese L, Botti M, Peri A, Cavazzi E, Latteri S, et al. 2017; Value of 3D printing for the comprehension of surgical anatomy. Surg Endosc. 31:4102–4110. DOI: 10.1007/s00464-017-5457-5. PMID: 28281114.

15. Oshiro Y, Mitani J, Okada T, Ohkohchi N. 2017; A novel three-dimensional print of liver vessels and tumors in hepatectomy. Surg Today. 47:521–524. DOI: 10.1007/s00595-016-1383-8. PMID: 27456277.

16. Rhu J, Kim MS, Kim S, Choi GS, Kim JM, Joh JW. 2021; Application of three-dimensional printing for intraoperative guidance during liver resection of a hepatocellular carcinoma with sophisticated location. Ann Hepatobiliary Pancreat Surg. 25:265–269. DOI: 10.14701/ahbps.2021.25.2.265. PMID: 34053930. PMCID: PMC8180396.

17. Ikegami T, Maehara Y. 2013; 3D printing of the liver in living donor liver transplantation. Nat Rev Gastroenterol Hepatol. 10:697–698. DOI: 10.1038/nrgastro.2013.195. PMID: 24126562.

18. Wang P, Que W, Zhang M, Dai X, Yu K, Wang C, et al. 2019; Application of 3-dimensional printing in pediatric living donor liver transplantation: a single-center experience. Liver Transpl. 25:831–840. DOI: 10.1002/lt.25435. PMID: 30770639.