Nov 17, 2015 | By Kira

On October 29th, 2015, a ten-year-old boy from Guizhou, China, underwent a high-risk liver transplant surgery at Shanghai General Hospital that was assisted by 3D printing technology. It was first case of a 3D printing assisted liver transplant in China’s historyYesterdaya full 18 days later, his doctors are happy to announce that both he and his mother, the liver donor, are recovering very well.

Zhihao suffered from cirrhosis of the liver, a serious condition where normal liver tissue is replaced by scar tissue (fibrosis), which blocks the flow of blood through the liver and slows the processing of nutrients, hormones, drugs, and naturally produced toxins. There is no reversal or cure for the disease—every year, roughly 31,000 people die from cirrhosis in the U.S. alone—and for severe cases such as Zhihao’s, a liver transplant is often the only treatment option.

As a major surgery, liver transplants and partial liver transplants are extremely risky procedures that come with a long list of requirements—including a healthy liver donor with matching blood type and similar body size. Luckily for Zhihao, his own mother was determined to be a willing donor with a matching blood type, however when it came to size, the doctors faced a problem. At just 10 years old, Zhihao already had a liver the size of a fully-grown adult, whereas the half of his mother’s liver that would be used in the transplant was just not big enough.

For successful partial liver transplants with living donors, the graft-recipient body weight ratio (GRWR) is desired to be 1% or more. Zhihao’s body weight of 44kg meant that, ideally, he required 440g of liver to be donated. Zhihao’s mother’s right liver lobe weighed close to 600g, whereas her left liver lobe was closer to just 300g. “If the right half of the liver were donated to Zhihao, the remaining liver volume is too small, it may lead to life-threatening liver failure for the mother herself,” explained Zhong Lin, head of the Hepato-Biliary-Pancreatic Surgery Department at Shanghai General Hospital. However, he continued, if the smaller left half of the liver were donated, it wouldn’t fulfill the required 1% weight ratio to ensure Zhihao’s recovery.

The choice was between removing too much, risking liver failure on the part of the donor, or removing too little for the recipient to survive.  As Zhihao’s condition continued to deteriorate, the doctors new they had to make the difficult decision immediately. They would also need to precisely plan how to work with the liver size, shape, blood vessels, and bile duct before the surgery, as even the smallest error could lead to surgical failure.

After careful consideration, Zhong Lin turned to 3D printing technology. The doctors 3D printed 1:1 scale models of Zhihao’s diseased organs as well as the transplant. By being able to view the preoperative organs in three-dimensional space, the doctors could accurately assess the extent of the disease and the relationship of adjacent organs and tissues in order to design a detailed surgery plan. After careful analysis and measurement, the doctors opted to use the smaller left half of the mother’s liver, identifying 307 grams that could be removed and attached to Zhihao’s diseased right half. Given that the liver is the only organ in the human body that can regenerate itself, they reasoned that if successful, the smaller half of the organ would be able to grow itself to full-size, saving both mother and son.

The doctors also brought the 3D printed models into the operation room during the liver resection in order to compare the real-time operation to the 3D model, providing intuitive navigation of the next surgical step.

Thanks to the 3D printing-assisted pre-planning, the surgery went smoothly. The Doctors were able to connect the smaller half of the mother's liver to Zhihao's left hepatic vein, left portal vein and left hepatic bile duct. After just two weeks of recovery, Zhihao's mother was discharged, and her son is happily in stable condition, with his liver expected to grow back to 60 per cent of its standard volume within a month.  “The boy’s liver will become very good. Because the transplanted liver will grow bigger and his damaged liver will gradually atrophy,” explained Peng Zhihai, director of the General Surgery Department at Shanghai General Hospital.

It could not have been an easy decision for the doctors to choose between potentially losing either a young boy or his mother, however thanks to the 3D printed models, they were able to accurately assess what was needed, and how the surgery could be successful without risking either patient’s lives. Of course, the credit can’t just go to the technology—as any parent would surely do, Zhihao’s mother made the important decision to donate a physical part of herself, and potentially risk her own life, to save her ten-year-old son. As 3D bioprinting technology continues to advance, we can only hope that, no mother, child, or doctor will be faced with these difficult decisions in the future.



Posted in 3D Printing Application



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