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Park, et al.
making a decision to proceed with transplantation based on used in 16 cases of LTs in small-sized recipients. The 3D
our 3D printed model. printed model can be utilized in real-world practice as a
In general, when height and weight are not so guide for LT in small-sized recipients to prevent large-
different between the donor and recipient, the graft for-size syndrome.
liver usually fits into the recipient’s abdominal cavity.
However, there lies a risk of large-for-size syndrome Acknowledgments
when small-sized patients, particularly female, are This research was supported by the Basic Research
matched to deceased donor. Among seven adult patients Program through the National Research Foundation of
of our study, five patients were managed to pivot from the Korea (NRF) funded by the Ministry of Science and ICT
initial plan established before deceased donor operation; (2020R1C1C1010525).
two patients were transplanted with organ from another
donor due to large-sized graft; one patient decided to Conflict of interest
undergo reduction of the original graft; one patient
decided to receive the whole liver while the initial plan The 3D printing protocol of intra-abdominal cavity for LT
was to perform a reduction hepatectomy; and one patient is under the process of patent registration.
decided to receive liver graft from living donor after Author contributions
deciding not to use a pre-allocated deceased donor graft;
The other two recipients received whole liver as initially Conceptualization: Jinsoo Rhu, Gyu-Seong Choi, Jae-
planned after comparing their 3D printed intra-abdominal Won Joh
cavity model with those grafts. Investigation: Jinsoo Rhu, Sunghae Park, Gyu-Seong
In pediatric LT, large-for-size syndrome can occur, Choi, Sanghoon Lee, Jae-Won Joh
especially in younger patients with lower weight. Among Methodology: Jinsoo Rhu, Sunghae Park, Jong Man Kim,
five pediatric patients, two patients decided to undergo Sanghoon Lee
reduction of the original graft after actual fitting of donor Formal analysis: Jinsoo Rhu, Sunghae Park
graft to 3D printed model of recipients. The other three Writing – original draft: Jinsoo Rhu, Sunghae Park
patients also underwent LT as initially planned after Writing – review & editing: Jinsoo Rhu, Sunghae Park,
fitting the donor graft to the 3D printed model. All donor Jong Man Kim, Jae-Won Joh.
grafts suited perfectly to the recipients’ abdominal cavity
and were successfully transplanted without having the Ethics approval and consent to participate
difficulty in closing abdominal wall of recipients. This study was approved by the Institutional Review
Our 3D printed model enabled fast printing with Board of Samsung Medical Center (IRB No. 2020-07-
low cost, which is essential for emergency operation 118). Informed consent was acquired from the recipients
such as DDLT. The median manufacturing times were who were enrolled prospectively after approval of the
568 min and 601 min for adult and pediatric recipients, Institutional Review Board; for minors, informed consent
respectively. Since most of time is consumed during 3D was obtained from their parents or legal guardians.
printing, the time can be shortened if multiple 3D printers
are used simultaneously or number of slices are lowered. Availability of data
The time consumed for printing the expected liver graft
was 25 – 40 h according to the study of Zein et al. From The datasets used and analyzed during the present study
[18]
the study of Wang et al. , the cost for printing the half- can be obtained from the corresponding author on request.
[19]
sized model of abdominal cavity and liver graft was US$ Further disclosure
929.6 and the time required for printing was approximately
48 h. Compared to the previous studies, our simplified 3D The paper has been uploaded in a preprint server (https://
printing model showed superior feasibility in time and cost. assets.researchsquare.com/files/rs-1294880/v1/090dd421-
Another strength of our model is that it only requires an ee52-429f-81bd-397dc2c0b049.pdf?c=1652850853).
FDM type 3D printer, which is cheaper and does not require
special facility. The strength can allow many transplantation References
centers to utilize the model in emergency cases.
1. Ahangar P, Cooke ME, Weber MH, et al., 2019, Current
5. Conclusion Biomedical Applications of 3D Printing and Additive

The 3D abdominal cavity model, which was made using Manufacturing. Appl Sci, 9:1713.
PLA filament and printed by FDM type printer, was https://doi.org/10.3390/app9081713
manufactured in <10 h with minimal amount and cost for 2. Daminabo SC, Goel S, Grammatikos SA, et al., 2020, Fused
filaments used. The 3D printed model was successfully Deposition Modeling-based Additive Manufacturing (3D

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