Objective Brain-dead donors serve as the primary source of hearts for transplantation globally.They are prone to severe hemodynamic instability and internal homeostatic disturbances. Inadequate management can exacerbate myocardial injury，leading to cardiac dysfunction and subsequent discard of the donor heart. Therefore，establishing a systematic and scientific framework for donor heart assessment and donor management is crucial for improving graft quality and utilization rates. Methods A retrospective analysis was conducted on the characteristics of brain-dead donors whose hearts（for clinical transplantation）were maintained and procured in the donor care unit（DCU）of the organ procurement organization（OPO）department at Zhongnan Hospital of Wuhan University between January 2021 and December 2025. Combined with a review of the literature，the experiencein managing and maintaining brain-dead donors for heart donation was summarized. Results During the study period，a total of 407 cases of donation after citizen’s death were maintained，a total of 95 hearts were procured for transplantation，yielding a utilization rate of 23.34%. The donor cohort comprised 82 males and 13 females，with a mean age of（44±10）years and body mass index（BMI）（23.71±3.35）kg/m2 . Comorbidities included a history of hepatitis B（n ＝ 5），hypertension（n ＝ 44），and diabetes（n ＝ 8）. Prior to procurement，none of the donors had active bloodstream infections. All donors were in sinus rhythm，with an average heart rate was（90.93±9.84）beats/min and mean arterial pressure of（78.47±16.69）mmHg（1 mmHg ＝ 0.133 kPa）. Key biochemical markers included high-sensitivity troponin Ⅰ 1.15×10-5 mg/L（2.70×10-5 mg/L）and N-terminal pro-brainnatriuretic peptide 2.63×10-4 mg/L（4.72×10-4 mg/L），data were expressed as median（interquartile range）. Hemodynamic support with low-to-moderate dose norepinephrine was required in 13 donors. The mean left ventricular ejection fraction of the procured hearts was（61.58±3.21）%. Left ventricular or septal wall thickening was observedin a few donors，with no wall thickness exceeding 14 mm. Conclusion Our data indicate that a systematic and scientific protocol for brain-dead donor heart assessment and management can maintain a relatively high utilization rate while ensuring graft quality. Rigorous monitoring of physiological parameters，proactive circulatory support，and judicious pharmacologic intervention are pivotal for preserving donor heart function. 

Objective This article aims to systematically review the domestic and international research status of simultaneous heart-kidney transplantation（SHKT），and explore the core key points of recipient selectionand evaluation，perioperative management and long-term postoperative follow-up. Methods A retrospective analysis was conducted on the characteristics of SHKT cases performed at Zhongnan Hospital of Wuhan University between January 2021 and December 2025. Combined with a review of the literature，the diagnostic and therapeutic experience for SHKT was summarized. Results A total of 3 cases of SHKT were included. All three recipients were male，with dilated cardiomyopathy and chronic renal insufficiency as the primary diseases，and were dependent on regular dialysis preoperatively. The surgical procedure involved immediate kidney transplantation following heart transplantation. Immunosuppressive induction was performed using either anti-thymocyte globulin（ATG）orbasiliximab，while the maintenance regimen consisted of tacrolimus，mycophenolate mofetil，and corticosteroids. The donor heart and kidney cold ischemic time were 127.33 min and 510.67 min，respectively. One patient developed delayed graft function postoperatively and required continuous renal replacement therapy（CRRT）. One patient diedon postoperative day 66 due to a concurrent infection with Enterobacter aerogenes and Pseudomonas aeruginosa，the remaining two patients have had favorable outcomes and remain alive to date. Conclusion Simultaneousheart-kidney transplantation is an effective treatment for end-stage heart disease with irreversible renal failure，demonstrating good short-，medium-，and long-term prognoses. Close collaboration within a multidisciplinary team，individualized immunosuppressive regimens，and a deep understanding of heart-kidney interactions are crucial forimproving graft and patient survival rates. 

Objective To investigate the predictive value of admission red blood cell distribution width （RDW）for early postoperative major adverse events in heart transplant recipients. Methods Clinical data of 57 patients who underwent heart transplantation at Central China Fuwai Hospital of Zhengzhou University between April 2018 and December 2024 were retrospectively analyzed. Patients were stratified into a favorable prognosis group （n ＝ 44）and an adverse prognosis group（n ＝ 13）based on the occurrence of major adverse events within 30 days postoperatively（all-cause death，reoperation for any cause，requirement for extracorporeal membrane oxygenation，or new-onset continuous renal replacement therapy）. Risk factors were screened using logistic regression analysis，and predictive performance was evaluated using receiver operating characteristic（ROC）curves. Results AdmissionRDW was significantly higher in the adverse prognosis group compared to the favorable prognosis group（15.69 ±1.32% vs. 14.70±1.56%，P ＝ 0.043）. Multivariate logistic regression analysis identified admission RDW as an independent risk factor for early postoperative adverse events（OR ＝ 1.875，95% CI ＝ 1.053 ～ 3.341，P ＝ 0.033）. The area under the ROC curve was 0.704（P ＝ 0.027），with an optimal cutoff value of 15.5%（sensitivity was 61.5%，specificity was 75.0%）. Conclusion Elevated admission RDW independently correlates with early major adverse events following heart transplantation and may serve as a potential biomarker for preoperative risk assessment. 

Objective To determine risk factors for acute kidney injury after heart transplantation by metaanalysis. Methods Relevant studies were retrieved from Web of Science，Embase，PubMed，Cochrane Library，CNKI，Wanfang，VIP and SinoMed，with the search period extending from database establishment to May 2025. RevMan 5.4 was applied for statistical synthesis. Results A total of 24 articles were included，involving 39 factors related to the literature，and the results of Meta-analysis showed that age，BMI，BSA，hypertension，diabetes，preoperative serum creatinine level，chronic kidney disease，operation time，cardiopulmonary bypass time，coldischemia time，intraoperative urine volume，intraoperative massive bleeding，intraoperative red blood cell transfusionand perioperative immunosuppressive use were the risk factors for acute kidney injury after heart transplantation（P ＜ 0.05）. Conclusion AKI after heart transplantation is influenced by multiple factors. Early identification of high-risk patients and implementation of standardized intervention strategies are essential to reduce its incidence. 

Objective To analyze and identify the risk factors for acute kidney injury（AKI）afterhearttransplantation（HT）and to develop a predictive model for early postoperative AKI in HT recipients. Methods A retrospective analysis was conducted on clinical data of HT recipients at Zhongnan Hospital of Wuhan Universityfrom January 2021 to October 2025. Patients were divided into AKI and non-AKI groups based on whether AKI occurred within 7 days post-surgery. Lasso regression and multivariate Logistic regression were used to screen forinfluencing factors. A nomogram prediction model was established using R language. The accuracy and discriminationof the model were evaluated using the area under the receiver operating characteristic curve（AUC-ROC）and calibration curves. Results Multivariate Logistic regression analysis showed that age（OR ＝ 3.848，95% CI ＝ 1.321 ～ 11.211），preoperative mean pulmonary artery pressure（MPAP）（OR ＝ 3.775，95% CI ＝ 1.564 ～ 9.111），preoperative serum creatinine（Scr）（OR ＝ 2.027，95% CI ＝ 1.239 ～ 3.315），and postoperative central venouspressure（CVP）（OR ＝ 2.376，95% CI ＝ 1.059 ～ 5.332）were four independent risk factors for AKI after hearttransplantation. The AUC of the nomogram model was 0.910（95% CI ＝ 0.848 ～ 0.971），and the calibration curveapproximated a straight line with a slope close to 1. Conclusion The model developed in this study for predicting AKI after HT demonstrates good reliability and clinical applicability. 

Objective This study aimed to investigate the role of the ubiquitin specific protease-7（USP7）in promoting cardiomyocyte proliferation and improving cardiac function following heart transplantation. Methods An adeno-associated virus serotype 9（AAV9）-mediated USP-7 overexpression system and a small-molecule activator，MS-8，were used in a mouse heart transplantation model to assess the effects of USP-7 on cardiomyocyte proliferation and graft function. Ki67，phospho-histone H3（pH3）and AuroraB immunofluorescence staining were performed to evaluate the proliferative capacity of cardiomyocytes. Cardiac function of the transplanted hearts was assessed by echocardiography，andhistological analyses were conducted to examine the structural integrity of the myocardium. Results RNA-seq analysis showed that USP-7 expression gradually decreased during cardiac development，while its activation significantly enhanced cardiomyocyte proliferation，as indicated by increased Ki67- and pH3-positive cell ratios. In the mouse heterotopic heart transplantation model，echocardiographic evaluation demonstrated that USP-7 overexpression markedly improved cardiac systolic function. Conclusion USP-7 promotes cardiomyocyte proliferation and protects cardiac graft function，thereby facilitating post-transplant myocardial repair. These findings identify USP-7 as a potential molecular target for regenerativetherapy after heart transplantation. 

Objective To explore the application effect of inhaled nitric oxide（NO）in the treatment ofsevere primary graft dysfunction（PGD）after lung transplantation. Methods Clinical data of 73 lung transplant recipients with severe PGD from January 2022 to June 2025 in Wuxi People’s Hospital Affiliated to Nanjing Medical University were retrospectively analyzed. Patients were divided into NO group（n ＝ 27）and control group（n ＝46）. Clinical baseline characteristics，intraoperative data，and postoperative outcomes were compared. Linear regression was used to analyze influencing factors of recovery time，and Cox regression was used for 28 d mortalityrisk factors. Results The ECMO duration in the NO group was significantly shorter than that in the control group （P ＝ 0.017）. Linear regression showed that NO was a favorable factor for shortening ECMO duration（β ＝ -0.402，P ＝0.023），invasive ventilation time（β= -0.361，P ＝ 0.036），and ICU stay time（β= -0.325，P ＝ 0.024）. Multivariate Cox regression showed donor age was an independent risk factor for 28 d mortality（P ＜ 0.05）. The 28-day survival rate was significantly higher in the NO group（85.2% vs. 63.0%，P ＝ 0.044）. Conclusion This study found that the NOgroup had shorter ECMO duration and higher 28 d survival rate，though further validation is required. 

Objective To investigate the effects of precision pulmonary rehabilitation based on individualized assessment under the multi-disciplinary treatment（MDT）model on the quality of life of patientsafter lung transplantation. Methods Sixty patients receiving successful lung transplantation at Wuxi People’sHospital Affiliated to Nanjing Medical University from January 2023 to September 2024 were assigned to the routine group and rehabilitation group（30 cases per group）by the random-number table method. The conventionalgroup received comprehensive treatment including medication， nursing， and rehabilitation education after lung transplantation ；The rehabilitation group implemented precise lung rehabilitation intervention under a multidisciplinary diagnosis and treatment model on the basis of the conventional group. Compare multiple indicators（lung function indicators，six minute walking distance，SF-36 score）between two groups of patients before and 3 months after surgery ；Compare the incidence of postoperative pulmonary complications and length of hospital stay between two groups simultaneously. Results There was no statistically significant difference in preoperative indicators between the two groups of patients（P ＞ 0.05）. At 3 months after surgery，both groups of patients showed significant improvement in various indicators compared to preoperative levels（P ＜ 0.05）. Three months aftersurgery，the rehabilitation group showed better lung function and exercise ability related indicators than the control group（P ＜ 0.05）；The scores and total scores of the six dimensions in the SF-36 scale were higher than those in the control group（P ＜ 0.05）；The postoperative hospital stay in the rehabilitation group was shorter than that in the control group（P ＜ 0.05），and the incidence of pulmonary complications such as pulmonary infection，atelectasis，and airway stenosis was lower than that in the control group（P ＜ 0.05）. Conclusion Implementing MDT-guided precision pulmonary rehabilitation after lung transplantation significantly enhances postoperative pulmonary function，exercise capacity，and quality of life，while reducing hospital stay and complication rates. This approach alleviates the economic burden on patients and comprehensively improves their long-term outcomes. 

Objective To explore the real experience of lung transplant recipients who have given up the process of returning to work，and to provide a reference for developing intervention programs for return to work in this population. Methods A purposive sampling method was used to select 15 lung transplant recipients whowere followed up in the outpatient clinic of Wuxi People’s Hospital. Data analysis and theme summarization were conducted using Colaizzi's seven-step method. Results Four themes and eight sub-themes were extracted ： ① Risk-avoidance oriented cognitive experience（fear of returning to work due to high infection risk perception，reluctance to return to work due to high environmental standards perception）；② Subjective perception oriented physical and psychological experience（concerns about returning to work due to perceived functional insufficiency， worries about returning to work due to low self-efficacy）；③ Bidirectional protection oriented comfort experience （strong self-protection awareness leading to unwillingness to return to work，family members' protective care obstructing return to work）；④ Job dilemma oriented decision-making experience（scarcity of decision-making resources and limited job options，health management needs influencing job selection）. Conclusion Returnto work among lung transplant recipients is interfered with by multiple factors. In the future，a three-dimensional intervention system of "risk prevention—confidence building—job matching" should be established to help patients develop correct rehabilitation and employment concepts，promote their return to work，and achieve comprehensive recovery.