Introduction:Structural complexities can render graft implantation infeasible in small paediatric recipients. Surgical decision-making currently relies on 3D medical imaging which limits evaluation of structures by presentation on 2D screens. As a solution we assessed the feasibility of using 3D printing to fabricate physical models in order to portray patient-specific anatomy and disease morphology. We assessed utility by using preliminary questionnaires (score 1-5, 1=not useful, 5= very useful). Methods: We describe 3 patients referred for living donor transplantation.Case 1:6 yr F (18 kg) with blocked IVC and jump PTFE graft (supra-coeliac to aortic bifurcation) for aneurysmal disease (model printed retrospectively). Case 2:2 yr M (12 kg) with renal and IMA aneurysmal disease whose model was printed prospectively to help plan surgery. Case 3:2 yr M (10kg) with previous laparotomies for bowel ischaemia (prospectively printed). Models were printed from segmented CT and MR data using a polyjet printer Objet500 Connex1. Results: All cases underwent successful procedures. Case 1:5 surgeons independently confirmed the 3D model would have been useful in preoperative planning and teaching (score 5). Case 2 underwent bilateral laparoscopic nephrectomy prior to living donor transplant. The operating surgeon pre-operatively confirmed the model provided reassurance (score 5). Intraoperative geometric anatomical correlation of the hilar vessels between the model and the patient scored 5. Case 3: The operating surgeon preoperatively scored the models as 5 with respect to planning and intraoperative correlation of vessel anatomy and placement of kidney as 4. The family found the models extremely useful in improving procedural understanding(score 5).Conclusion:To our knowledge these are the first reported cases of 3D printing in paediatric renal transplantation. Our initial experience proves promising with clinical translation, providing full 3D haptic spatial appreciation for making critical decisions. We believe 3D models are valuable in consenting families, especially when precise risks are not always quantifiable as is often the case in transplanting small children with anomalies and previous surgery.

CITATION INFORMATION: Chandak P, Byrne N, Karunanithy N, Callaghan C, Mushtaq I, Marks S, Stajonovic J, Ahmed Z, Kessaris N, Mamode N. Using 3D Printing in Complex Pediatric Renal Transplantation. Am J Transplant. 2016;16 (suppl 3).

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