Kidney transplantation poses particular surgical challenges when the organ recipients are young children. Now, Chandak and colleagues show that 3D printing can be used to determine operative feasibility in cases of complex paediatric renal transplantation.

The researchers report three cases of young children with end-stage renal disease that required transplantation, each posing distinct challenges to the surgical team. In the first case, there was a large size difference between the young child’s small abdomen and the adult donor kidney. The second patient presented with vascular anatomy abnormalities and the third child required a staged operation due to severe aneurysmal disease.

Chandak says that in all three cases the viability of transplantation was difficult to ascertain based on the review of conventional imaging. “These circumstances would normally require on-table exploration of the child to confirm operative feasibility and we were keen to use patient-specific 3D printing to pre-operatively assess feasibility and reduce risk,” he explains.

Using anatomical geometry data obtained from MRI or computed tomography (CT) scans, the researchers created patient-specific models of relevant anatomical structures. The models included not only donor and recipient kidneys but also vasculature and the abdominal cavity. Following image segmentation and editing, the models were verified by a radiologist and printed using polyjet technology. The final 3D-printed models were then used in multidisciplinary discussions ahead of transplantation to enable simulation and detailed planning of the surgical procedure.

“In our centre, 3D printing is now an integral part of the clinical workflow, and patient-specific 3D models are used in our multidisciplinary discussions of complex cases,” remarks Chandak. “We hope that accessing this technology will provide clinical teams with an additional layer of planning opportunity when dealing with high-risk transplantation in children.”