The feasibility of medial segment graft in pediatric liver transplantation revisited by three-dimensional printing
jpedsurg.org shows its articles on its own site.
Read the article on jpedsurg.org ↗Article · Mar 2021 · 1 min read
In brief
In brief
Retrospective study of 291 liver donors demonstrates that medial segment grafts are anatomically feasible in 33% of cases, with mean graft volume of 234ml suitable for pediatric recipients. Using 3D printing models and ex vivo practice on explanted livers, authors propose procurement techniques and recommend initial clinical implementation as auxiliary partial grafts to maximize safety.
Written by the GCMD Library team from the article.
Abstract
Background
The medial segment as a mono-segmental graft was proposed to increase the donor pool for pediatric liver transplantation, but to date, there has been no published case. This study aims to revisit the feasibility of procuring the medial segment graft (MSG) by three-dimensional (3D) printing and ex vivo procedures performed on explanted diseased livers to overcome the gap between theory and clinical implementation.
Methods
From October 2004 to December 2016, we retrospectively analyzed preoperative computed tomography, magnetic resonance cholangiopancreatography, and intraoperative cholangiography images of our previous live liver donors and identified the indicated anatomy for the MSG, then materialized by 3D printing models to simulate the engraftment. Furthermore, we practiced the procurement procedures on selected explanted diseased livers.
Results
Among 291 analyzed livers, 96 livers (33%) met the arterial criteria for MSG, and two-thirds of them had ideal portal branches for reconstruction. The proposed right border of the MSG was the Cantlie's line, and the left edge was the right side of the umbilical fissure. The mean estimated volume of the MSG was 234 ± 54 ml. Besides, we suggest implanting the MSG as an auxiliary partial graft in an inverted vertical position or a standalone graft with right-side rotation in the right subphrenic space.
Conclusion
The procurement of the MSG is feasible based on our results. However, due to the novelty of the procedure, we suggest that the first attempted case of MSG should be implanted as an auxiliary partial graft to maximize patient safety.
Level of Evidence
Type of study: Case series with no comparison groups
Evidence level
Level IV.