A novel preoperative simulation approach for pediatric kidney transplantation to support donor-recipient size matching using dialysis fluid-enhanced CT imaging and 3D printing.

Background: Size mismatch between adult donor kidneys and small pediatric recipients remains a significant technical challenge in pediatric kidney transplantation. To address this, we explored a novel preoperative method to evaluate donor-recipient anatomical compatibility. Methods: Three pediatric recipients underwent pre-transplant assessments using segmented CT data from living donors to generate patient-specific 3D-printed kidney models. Digital simulation was performed by virtually positioning the donor kidney within fluid-enhanced recipient CT datasets acquired following intraperitoneal dialysis fluid administration. It was hypothesized that this combined approach would enable objective preoperative assessment of spatial fit and surgical feasibility. Results: The preoperative simulation and modeling approach contributed to successful kidney transplantation in all three children without intraoperative complications attributable to graft placement. Postoperative recovery was uneventful, and graft function remained satisfactory at 6-month follow-up. Conclusion: The integration of 3D-printed donor kidneys with digital simulation based on dialysis fluid-enhanced CT imaging offers a feasible approach for preoperative donor-recipient size matching in small pediatric recipients. This method may enhance surgical planning, allow safer use of living-donor organs in very small children, and reduce time spent on dialysis.