Objective To analyze the causes and characteristics of death of kidney transplant recipients. Methods "Kidney transplantation" "death" and "cause" were searched in the retrieval system of China Biomedical Literature Database，China National Knowledge Network and Wanfang Medical network，and the 15 literatures included were statistically analyzed. Results A total of 18 070 kidney transplant recipients from 1977 to 2018 were included，and 2 286 of them died，with the mortality rate ranging from 2.0% to 35.7%，and the overall mortality rate was 12.6%（2 286/18 070）. The causes of death included 810 cases（35.4%）of infection，787 cases（34.4）of cardiovascular and cerebrovascular diseases，344 cases（15.1%）of liver failure，73 cases（3.2%）of gastrointestinal diseases，69 cases（3.0%）of tumor，19 cases（0.8%）of accidental death，10 cases（0.5%）of economic factors，and 174 cases of other causes（7.6%）. Conclusion Infection and cardiovascular and cerebrovascular diseases were the main causes of death in kidney transplant recipients，liver failure was the secondarycause，and gastrointestinal diseases and tumors were the rare causes，and other causes were rare. 

Objective The clinical effects of single lung transplantation （SLT）and bilateral lung transplantation（BLT）in the treatmentof end-stagepulmonaryfibrosiswere compared to provide a reference for the choice of clinical treatment. Methods Retrospectiveanalysisofpatients withpulmonaryfibrosis who underwent lung transplantation at Wuxi People's Hospital affiliated to Nanjing Medical University between February 2020 and December 2020 was performed，a total of 72 patients were included，and were divided into two groups based on the type of surgery, including single-lung transplantation group（24 cases）and bilateral-lung transplant transplantation group（48 cases）. Preoperative characteristics，intraoperative conditions，functional improvement andpostoperative complications between the two groups were analyzed retrospectively. Results TheageinSLT groupwas significantly older than the BLT group〔65（57，69.75）years vs 55（48，61.75）years，P ＜ 0.05〕，which was in consistent with the fact that single lung transplantation was mostly performed in the elderly patients in this center. The two groups were comparable in other preoperative clinical data（P ＞ 0.05）. The predicted value of FVC% and FEV1% in the BLT group were better than those in the SLT group（P ＜ 0.05）. However the cold ischemia timeand total operation time were shorter in the SLT group than in the BLT group，and the intraoperative blood loss was less in SLT group than that in the BLT group（P ＜ 0.05）. There were no significant differences between the twogroups in the incidence of bronchial stenosis，bronchial stenosis，bronchial stenosis and primary graft dysfunction （P＞0.05）. Conclusion BLT has advantages in treating patients with end-stage pulmonary fibrosis and can effectively improve postoperative lung function，but SLT should still be considered in some selected patients. 

Objective To improve the management of individualized drug therapy and drug safety inpregnancy patients after kidney transplantation，and to reduce maternal and fetal adverse events. Methods Toformulate individualized medication regimen and provide medication education from the aspects of adjustment ofimmunosuppressants，optimization of antihypertensive drugs，supplementation of folic acid，selection and monitoring ofanticoagulant drugs，monitoring of high uric acid and lactation were conducted. Results First trimester : The blood HCGinspection was positive indicating pregnancy .The patient's medication regimens were adjusted to the immunosuppressanttacrolimus capsule（5 mg Bid），hypotensor nifedipine controlled release tablets（30 mg QD），folic acid tablets（5 mg QD），dydrogesterone table（10 mg Q12 h）. Second trimester ：anticoagulant therapy of dapheparin sodium injection（5000 U/d）was given. At the same time，oral tacrolimus（5 mg Bid）was continued to maintain immunotherapy，and nifedipinecontrolled release tablet（30 mg QD）was used to reduce blood pressure. Perinatal period ：dexamethasone intramuscular（6 mg Q12 h）injection was given to promote fetal lung maturation and reduce lung complications of premature newborns.To prevent infection，Ceftazidime injection（2 g Bid）and metronidazole sodium chloride injection（100 ml Qd）weregiven for 5 d . Leonurus intramuscular injection was 1 ml to promote uterine contraction，in the meantime, the patients continueto take tacrolimus to maintain immunotherapy and nifedipine to reduce blood pressure. Conclusion The cooperation amongphysicians，pharmacists and nurses could provide whole-process management for kidney transplantation patients and improvetreatment effect. Meanwhile，pharmacists can effectively improve clinical dialectical thinking and evidence-based thinking throughparticipating in the whole process of treatment practice，laying a foundation for improving the level of pharmaceutical care.

Objective To evaluate the significance of detecting cytomegalovirus antigenemia in thediagnosis of cytomegalovirus infection in renal transplant patients. Methods From September 2021 to December2021，a total number of 110 blood samples from 90 renal transplant patients in The First Hospital of Kunming were collected.The CMV pp65 antigenemia test was compared with the results of IgG antibody and CMV DNA. The correlation betweenthe CMV pp65 antigenemia results and creatinine，tacrolimus（tacrolimus，Tac/FK506）concentration，lymphocyte subsetswas evaluated. Results The consistency between CMV pp65 antigenemia results and CMV DNA results was 65.5%，the difference was statistically significant（P ＜ 0.05）. The consistency between the CMV pp65 antigenemia test resultsand the CMV IgG antibody test results was 57.3%，the difference was not statistically significant（P ＞ 0.05）. There wasno significant difference between CMV pp65 antigenemia results and creatinine as well as FK506 drug concentrations（P ＞ 0.05）. In the comparison between CMV pp65 antigenemia results and lymphocyte subsets，there was only astatistically significant difference between CMV pp65 and NK cell absolute value（P ＜ 0.05）. Conclusion Theconsistency between CMV pp65 antigen and CMV IgG antibody was 57.3%. The consistency between CMV pp65 antigenand CMV DNA was 65.5%. The combined detection of CMV pp65 antigen and CMV DNA has certain significance inimproving the accuracy of clinical diagnosis of CMV infection. There was no statistically significant difference in the serumcreatinine level and the whole blood FK506 drug concentration between the CMV pp65 antigen negative group and thepositive group. The absolute value difference of NK cells was statistically significant. The probability of CMV infection inrenal transplant patients with high absolute value of NK cells was low.

Objective To investigate the effect of donor quality on the survival rate of liver transplantationrecipients after cardiac death organ donation（DCD）. Methods A retrospective analysis was performed on 100 patients who received DCD liver transplantation from January 2018 to January 2021. A 1-year follow-up survey was conducted after transplantation to observe the survival status of liver transplantation recipients and to analyze the risk factors affecting liver transplantation recipients. Results The mortality rate of liver transplantation recipientswas 3%（3/100）. The mortality factors were closely related to the donor cold ischemia time，donor fatty liver，intraoperative blood loss，donor albumin and total bilirubin levels，and hepatocyte edema（P ＜ 0.05）. MultivariateLogistic regression analysis showed that donor cold ischemia time ≥ 840 min and fatty liver were independent risk factors for survival status of liver transplantation recipients（P ＜ 0.05）. The postoperative infection rate of liver transplantation was 26%（26/100），and the postoperative infection rate was closely correlated with child-Pugh scoreof recipient，preoperative hemoglobin level，platelet count，intraoperative blood transfusion volume and postoperative intensive care unit（ICU）observation time（P ＜ 0.05）. Conclusion DCD donor quality has a significant impact on the survival rate of recipients after liver transplantation，and the donor cold ischemia time and fatty liver have an important impact on the survival status of recipients after liver transplantation，while the preoperative anemia level，intraoperative blood loss and postoperative ICU observation time of recipients are closely related to the incidence of postoperative infection. 

Objective Examining the effects of donor-recipient age gap and donor liver weight-torecipient weight ratio on postoperative wound infection in recipients. Methods Clinical data of patients undergoing liver transplantation at Renmin Hospital of Wuhan University from June 1，2017 to September 1，2023 were retrospectively collected.Differences in donor infection rates between groups before and after propensity scoringwere analyzed by chi-square test. Results The donor-recipient age gap was greater than or equal to 10 yearsin 32 cases. A total number of 51 cases had a donor-recipient age gap less than 10 years. Pre-propensity score ：no difference in early infection rate. Late infection rate did not differ. The ratio of donor liver weight to recipient body weight was greater than 0.01 in 46 cases. The ratio of donor liver weight to recipient body weight was less thanor equal to 0.01 in 37 cases. Before propensity scoring ：early infection rate did not differ. Late infection rate didnot differ. A total number of 32 donor-recipients had an age difference greater than or equal to 10 years. Thirtytwo patients with a donor-recipient age gap less than 10 years were matched according to 1 ∶ 1. After propensityscoring ：early infection rates were statistically different（χ2 ＝ 4.27，P ＝ 0.04）. There was no difference in therate of late infection. A total number of 37 patients have a donor liver weight-to-recipient weight ratio less thanor equal to 0.01. A total number of 37 patients with a donor weight-to-recipient weight ratio greater than 0.01 were matched according to a 1 ∶ 1 ratio. After propensity scoring ：early infection rates were statistically different （χ2 ＝ 9.95，P ＜ 0.01）. There was no difference in the late infection rate. Conclusion Donor-recipient agegreater than 10 years and donor liver weight to recipient body weight ratio less than or equal to 0.01 were risk factors for early postoperative wound infection in recipients. 

ObjectiveTo analyze the independent risk factors for achieving a textbook outcome （TO） inliver transplant （LT） surgery for patients with hepatocellular carcinoma. MethodsRetrospective analysis of clinical diagnosis and treatment data of patients with HCC who underwent LT in the Liver Transplantation Department of Sun Yatsen Memorial Hospital， Sun Yat-sen University from June 2019 to December 2022 was performed. A total of 134 patients were included， including 124 males and 10 females， with a median age of 54（47 ～ 60） years. According to whether TO was achieved， they were divided into the TO group （n ＝ 41） and the non-TO group （n＝ 93）. Univariate and multivariatelogistic regression analyses were used to identify independent factors affecting TO. ResultsApproximately one-third（30.6%） of hepatocellular carcinoma patients achieved tumor obliteration （TO） after liver transplantation （LT）. Multivariate analysis showed that preoperative bilirubin ≥ 54.1 mmol/L （OR ＝ 9.75，95% CI ＝ 2.01 ～ 47.28，P ＝ 0.005） and biliary stasis in donor liver （OR ＝ 2.93，95% CI ＝ 1.21 ～ 7.13，P ＝ 0.018） were independent risk factors for achieving TO. Further analysis revealed no statistical difference in long-term survival rates between the TO group and non-TO group （χ2 ＝ 1.127，P ＝ 0.288）. ConclusionPreoperative high serum bilirubin and cholestasis in the donor liver areindependent risk factors for achieving TO after liver transplantation in patients with hepatocellular carcinoma. Currently， no differences have been found in the long-term survival rates between different groups. As a comprehensive indicator of shortterm prognosis，TO can be used to compare the quality of nursing among different centers after liver transplantation.

肾移植 ； 肺部感染 ； 宏基因二代测序 ； 治疗经验

Objective To investigate the expression and scientific significance of PBRM1 in renal transplantation ischemia reperfusion injury（IRI）. Methods Three groups of kidney tissues（5 cases in eachgroup）were selected and divided into normal kidney group（Control），stable allograft function（STA group），and ischemia injury（IRI group）. The expression of polybromo 1（PBRM1）in the three groups was detected by immunohistochemistry. The expression of PBRM1 after renal IRI was analyzed with Gene Expression Omnibus（GEO）data set and its mechanism was discussed. Finally，the expression of Pbrm1 in Th17 cells was verified in vitro. Results Immunohistochemical staining showed that the expression of PBRM1 in IRI group was significantly higher than that in the other two groups. GSE180420 database analysis showed that PBRM1 expression was significantly increased in IRI group compared with Control，and GSEA results suggested that PBRM1 could promote the function of Th17 cells. In vitro experiments confirmed that the transcription level of Pbrm1 was significantly increased in Th17cells compared with Th0 cells. Conclusion The expression of PBRM1 was significantly increased after renal IRI transplantation. PBRM1 may aggravate renal IRI by affecting the function of Th17 cells. 

Objective To analyze the factors affecting the delayed extubating of endotracheal intubationafter liver transplantation. Methods The medical records of liver transplantation patients under general anesthesiain Eastern Theater General Hospital from September 1，2020 to March 31，2023 were collected retrospectively. Accordingto the extubating time，they were divided into the early extubating group within 1 h after extubating and the delayedextubating group within 3 h after extubating. ，Extubating difficult group extubating 24 h without extubating. The clinicaldata of the three groups of liver transplant recipients were compared，and the risk factors of prolonged extubating time afterliver transplantation were analyzed by univariate analysis and multivariate Cox regression analysis. Results A total of237 patients were included，including 82 cases（34.60%）in the early extubating group，119 cases（50.21%）in the delayedextubating group，and 36 cases（15.19%）in the difficult extubating group. The results of univariate analysis showedstatistical differences in age，body mass index（BMI），Child-Pugh score，MELD score，duration of liver-free period，type of inotropes，mean intraoperative body temperature，and minimum body temperature after reperfusion between thethree groups（P ＜ 0.05）. Multifactorial Cox regression analysis showed that increased age（HR ＝ 0.980，95% CI ＝0.966 ～ 0.994，P ＝ 0.005），high MELD score（HR ＝ 0.966，95% CI ＝ 0.941 ～ 0.991，P ＝ 0.009），and intraoperativepumping of rocuronium were independent risk factors for delayed postoperative extubating，and cis-atracurium comparedwith rocuronium（HR ＝ 1.834，95% CI ＝ 1.244 ～ 2.703，P ＝ 0.002），and meclizine compared with rocuronium（HR ＝1.660，95% CI ＝ 1.073 ～ 2.567，P ＝ 0.023）. Higher mean body temperature（HR ＝ 2.447，95% CI ＝ 1.449 ～ 4.132，P ＝ 0.001）and higher minimum body temperature after reperfusion（HR ＝ 1.288，95% CI ＝ 1.023 ～ 1.622，P ＝ 0.031）were in favor of shorter extubating time. Conclusion Increasing age，high MELD score，and intraoperative pumping ofrocuronium were independent risk factors for delayed postoperative extubating，and intraoperative use of cis-atracurium，vecuronium，and aggressive temperature protection favored rapid postoperative extubating.