Objective To study the related factors for significant intraoperative blood loss and their impact on prognosis in children with biliary atresia who underwent liver transplantation for the first time. Methods The data of children with biliary atresia who underwent liver transplantation at the Department of Liver Transplantation，Tianjin First Central Hospital from July 2020 to December 2024 were collected and analyzed. Risk factors for massive estimated blood loss （EBL）were analyzed using univariate logistic regression and multivariate logisticregression analysis. The postoperative complications of the two groups，including hepatic artery embolism， biliary complications， intestinal fistula， etc.，were analyzed and compared by chi square test. Log-rank test and KaplanMeier curve were used to analyze the recipient and graft survival rate of the two groups. Results A total numberof 662 patients with biliary atresia were enrolled in the study. Ninety-nine patients had massive EBL. UnivariateLogistic regression analysis showed that the recipient's age， height，INR，operation time and transplant type were the risk factors of massive EBL during liver transplantation in children with biliary atresia. Multivariate logisticregression analysis showed that prolonged operation time（≥ 10 hours），age ＜ 6.5 months， body hight ＜ 70 cm， transplant with reduced-sized left lateral lobe and INR ≥ 2.35 were important independent risk factors for massive EBL. The incidence of hepatic artery thrombosis ， ischemic biliary complications，intestinal leakage and pulmonaryinfection in massive EBL group were significantly higher than those without massive EBL（9.1% vs. 3.2%，11.1% vs. 5.3%，2.0% vs. 0.9%，25.3% vs. 13.7%，all P ＜ 0.05）. The 3-year recipient survival rate of massive EBL patientswas significantly lower than that of patients without massive EBL（93.9% vs. 97.2%，P ＜ 0.05）. Conclusion For children with biliary atresia who undergo liver transplantation for the first time，the use of reduced-size grafts should be minimized and the surgery time should be shortened to ensure surgical safety. For children without growth disorder， surgery could be performed when the hight reaches 70 cm and the age reaches 6.5 months. Preoperative correction ofcoagulation function when INR drops below 2.35 and reducing intraoperative bleeding is of great significance to the prognosis of children. 

Objective To investigate the application effect of the multidisciplinary collaborationmodel under the concept of enhanced recovery after surgery （ERAS） in simultaneous pancreas-kidneytransplantation. Methods Forty-seven recipients who underwent their first simultaneous pancreas-kidney transplantation from April 2020 to August 2024 in the Second Affiliated Hospital of Guangxi Medical University were selected as the research subjects and randomly divided into the control group and the observation group. The control group received routine postoperative care， while the observation group was nursed under the multidisciplinary collaboration model based on the ERAS concept. Results The postoperative fasting blood glucose of the observation group was lower than that of the control group， and the length of hospital stay was shorter， with statistically significant differences（P ＜ 0.05）. There were no statistically significant differences in glycated hemoglobin， serum creatinine values， early postoperative complication rates， and survival outcomes between the two groups （P ＞ 0.05）. Conclusion The multidisciplinary collaboration model based on the ERAS concept in the nursing of patients undergoing simultaneous pancreas-kidney transplantation has achieved favorable outcomes， promoting the recovery of pancreatic function， shortening the hospitalstay， facilitating early recovery of patients， and enhancing patient satisfaction. 

Objective To evaluate the clinical efficacy of avatrombopag in the treatment of severethrombocytopenia during the perioperative period of liver transplantation， and to compare it with recombinant human thrombopoietin （rhTPO） and platelet transfusion. Methods A retrospective analysis was conducted on 88 patientswho developed severe thrombocytopenia after liver transplantation between May 2019 and December 2023 in TongjiHospital， Tongji Medical College， Huazhong University of Science and Technology. Patients were divided into threegroups based on treatment: avatrombopag group （n ＝ 33）， rhTPO group （n ＝ 27）， and platelet transfusion group（n＝28）. The primary endpoint was the effective rate, which was defined as platelet count ＞50×109 /L or an increase＞ 20×109 /L on day 7 post-treatment. Results The avatrombopag group achieved a significantly higher effective rate of 96.97% on day 7 compared to the rhTPO group （70.37%，P ＝ 0.008） and platelet transfusion group （60.71%，P ＜ 0.001）. Platelet counts in the avatrombopag group showed significant improvement from day 3 and reached effective levels by day 5 in most patients. Baseline characteristics were comparable across groups. Conclusion Avatrombopag demonstrates superior efficacy over rhTPO and platelet transfusion in managing severe perioperativethrombocytopenia following liver transplantation， with rapid onset and favorable safety profile. Further multicenter randomized controlled trials are warranted. 

Objective To explore the risk factors of invasive pulmonary aspergillosis （IPA） after organ transplantation and establish a Nomogram risk prediction model. Methods A total of 612 patients undergoing organ transplantation admitted to Hebei Yanda Hospital from January 2018 to January 2024 were randomly divided into training set （n ＝ 408） and verification set （n ＝ 204）. The patients in the training set were divided into IPA group （n ＝ 29） and non-IPA group （n ＝ 349） according to whether they had concurrent IPA or not. Factors of IPA were analyzed， and a Nomogram model was established and verified. Results The incidence of IPA was7.76%. Age， diabetes， chronic obstructive pulmonary disease， bronchitis， antibiotic usage time and invasive mechanical ventilation were independent risk factors for IPA after organ transplantation （OR ＝ 3.438，3.743， 3.219，3.149，3.747，3.053，P ＜ 0.05）， and immunosuppresant dose adjustment was its protective factor （OR ＝0.556，P ＜ 0.05）. Based on the above factors， a Nomogram model was established to predict the IPA after organtransplantation， the model showed good discrimination and ideal predictive performance， and net benefits could be obtained. Conclusion Age， diabetes， chronic obstructive pulmonary disease， bronchitis， antibiotic usage time andinvasive mechanical ventilation are independent risk factors for IPA after organ transplantation， and immunosuppresant dose adjustment is its protective factor. The Nomogram model constructed based on this has good predictive performance. 

Objective To investigate the application effect of the multidisciplinary collaborationmodel under the concept of enhanced recovery after surgery （ERAS） in heart transplantation. Methods Retrospective analysis of the clinical data of patients undergoing heart transplantation in the 7th People's Hospital of Zhengzhou from 1 May 2018 to 31 October 2024 was performed. Transpulmonary pressure gradient cut-off values were calculated. The patients were grouped according to the cut-off values， and the baseline and prognostic data of the two groups were compared. Results The 331 adult heart transplant patients were included in this study. The TPG cut-off value of 12 mmHg was calculated by X-tile software. The 331 patients were divided into two groupsTPG ＞ 12 mmHg（93 patients）and TPG ≤ 12 mmHg（238 patients）. The results of univariate analysis showed significant differences between the two groups in cardiac discharge index， mean pulmonary artery pressure， PAWPand PVR（P ＜ 0.001），No differences were observed in recipient gender， blood group， MV， ECMO， IABP，CRRT， preoperative cytomegalovirus （CMV） infection， pretransplantation infection， recipient age， height， weight，recipient right ventricular mass， recipient left ventricular mass， donor age， donor weight ， donor height， recipient right ventricular mass， recipient left ventricular mass， donor age， donor height， recipient right ventricular mass，recipient left ventricular mass， donor age， donor weight， donor height， recipient right ventricular mass， recipient left ventricular mass， donor sex， donor blood type， cold ischaemia time， ascending aortic block time， postoperative IABP， postoperative ECMO and postoperative CRRT （all P ＞ 0.05）. In terms of prognosis， the prognostic analysisshowed that there were statistically significant differences between the two groups in terms of extracorporeal circulation time， duration of surgery， survival time， survival， length of stay in the care unit， and length of postoperative hospitalisation（P ＜ 0.05）. Survival analysis showed that TPG ≤ 12 mmHg group had a significantly higher survivalrate than the TPG ＞ 12 mmHg group（P ＜ 0.05）. The right ventricular mass disparity ratio and patient survivalquality showed a linear relationship， right ventricular mass difference ratio ＞ 0.13 will increases the survivalrate of patients. Conclusion Pre-transplant TPG ＞ 12 mmHg significantly reduces the survival prognosis of heart transplant patients， and there is a linear relationship between the right ventricular mass difference ratio and the survival quality of patients， the right ventricular mass difference ratio ＞ 0.13 improves the survival prognosis of patients. 

Objective To explore the risk factors for massive blood loss during pediatric living donor livertransplantation（LDLT）and their impact on prognosis. Methods A retrospective analysis was conducted on theclinical data of 43 pediatric patients who underwent LDLT between August 2014 and December 2024 at the Department ofPediatric Surgery， First Affiliated Hospital of Xinjiang Medical University. Among the patients，20 cases were male and 23 cases were female， the mean age was 5.9（5） years（range ：0.42 ~ 15 years）and the mean weight was 20.5（14.6）kg （range ：4.93 ~ 50 kg）. The primary diagnoses included 14 cases of biliary atresia，9 cases of Wilson's disease，5 cases of portal vein cavernous transformation， and 15 cases of other liver diseases. Massive blood loss（estimated blood loss， EBL）was defined as blood loss exceeding one circulating blood volume within 24 h. Patients were divided into two groups ： themassive EBL group（8 cases）and the non-massive EBL group（33 cases）. Two patients with incomplete clinical data wereexcluded. Descriptive statistical analysis was used to assess patient characteristics and surgical details. Univariate logisticregression was performed to identify factors associated with massive EBL， and χ2 tests were used to compare the incidence of portal vein complications between the two groups. Kaplan-Meier curves were utilized to compare the overall recipient and graft survival rates between the two groups. Results The incidence of intraoperative massive bleeding was 19.5%（8 cases）. Univariate logistic regression analysis revealed that the international normalized ratio （INR）， operation time， and cold ischemia time were significant factors associated with massive estimated blood loss （EBL） during liver transplantationin children with biliary atresia， and these factors also showed a significant correlation with intraoperative blood transfusion. χ²  tests showed that the incidence of postoperative complications， including respiratory infections， lymphatic leakage， andprimary non-function（PNF） of the graft were significantly different between the massive EBL group and non-massive EBL group. However， the cummulative overall survival rate and cummulative graft survival rate showed no significant differences between the two groups. Conclusion Higher preoperative INR， longer cold ischemia time， and extended surgical timemay significantly increase the risk of massive blood loss during pediatric liver transplantation. Strengthening preoperative coagulation function assessment and optimizing surgical procedures can help reduce the incidence of massive blood loss andimprove prognosis. 

Objective To explore the physiological and psychological factors affecting pulmonary infection in kidney transplant recipients and to construct a risk prediction model. Methods The clinical and follow-updata of 327 recipients undergoing kidney transplantation in Shandong Provincial Qianfoshan Hospital from January2019 to January 2024 were retrospectively analyzed. The recipients were divided into pulmonary infection group（102 cases）and non-pulmonary infection group（225 cases）according to whether pulmonary infection occurred after kidney transplantation. The data of the two groups of recipients was analyzed with multivariate regression analyze，theprediction model of pulmonary infection of kidney transplant recipients was constructed，and the receiver operatingcharacteristic（ROC）curve was used to verify the predictive value. Results The rate of pulmonary infection within 1 years after kidney transplantation was 31.19%. Age，blood glucose，insomnia severe index，use of cyclosporine and mycophenolate mofetil were independent risk factors for pulmonary infection. While white blood cell count on postoperative day 5 and positive psychological capital were independent protective factors（P ＜ 0.05）.The areaunder curve（AUC）of the constructed model equation for predicting the risk of pulmonary infection was 88.7% with a Kappa value of 0.66（P ＜ 0.05）. Conclusion The prediction model of pulmonary infection in kidney transplant recipients constructed based on physiological and psychological factors has a good predictive value. 

Objective To improve the accuracy and clinical interpretability of recurrence prediction after liver transplantation in patients with hepatocellular carcinoma（HCC），and to explore the potential application of explainable machine learning models in integrating multimodal data. Methods This study included data from 138 liver transplant patients with liver cancer at the Third Medical Center of the Chinese People's Liberation Army General Hospital from December 2018 to December 2021. Preoperative contrast-enhanced CT radiomics features and clinical variables were extracted. Predictive models were developed using four machine learning methods ：LASSO regression，random forest，support vector machine（SVM），and neural network. Importance of variate was employed to identify key predictive factors. Model performance was evaluated using area under the receiver operating characteristiccurve（AUC），Brier score，and calibration curves. A nomogram was ultimately constructed based on important variables. Results The AUCs for the random forest model in predicting recurrence at 1，2，and 3 years were 0.881，0.906，and 0.915，respectively，significantly outperforming other models. The importance analysis identified five key imaging features，and the nomogram model combining these with clinical variables demonstrated good consistency and predictive capability. Conclusion Explainable machine learning models based on multimodal data can effectively improve the accuracy and transparency of recurrence prediction following liver transplantation in HCC patients. These models have strong clinical applicability and provide valuable support for individualized preoperative risk assessmentand treatment decision-making. 

Objective To investigate the clinical efficacy of peptide receptor radionuclide therapy （PRRT）in patients with recurrent neuroendocrine tumors （NETs） after liver transplantation. Methods A retrospective analysis was conducted on the clinical data of 5 patients with recurrent NETs after liver transplantation who underwent PRRT from April 2023 to May 2024 in Tianjin First Central Hospital. Adverse reactions and treatment efficacy were evaluated. Results The median follow-up was 15.6 months. Among the patients，1 achieved partial response （PR），3 had stable disease （SD）， and 1 experienced progressive disease （PD）. Liver function remained stable during treatment， and no rejection reactions occurred. Grade 3 neutropenia was observed in 2 cases， while grade 2 neutropenia occurred in 3 cases. Symptomatic treatment alleviated the condition in 4 cases， but 1 case had persistent severe neutropenia， leading to treatment discontinuation. Grade 1 ～ 2 proteinuria was observed in 2 cases. Conclusion PRRT is safe and effective for patients with recurrent NETs after liver transplantation. The main side effect is neutropenia， and PRRT can be considered as one of the multimodal treatment options.