Objective To explore the risk factors for recurrent （≥ 2 times） pneumonia in elderlykidney transplant recipients after surgery. Methods Retrospective analysis was performed from the clinical data of 119 elderly kidney transplant recipients who underwent kidney transplantation at the Eighth Medical Center of the People's Liberation Army General Hospital from January 2010 to January 2024. According to whether pneumonia occurs repeatedly （≥ 2 times） after kidney transplantation， elderly recipients were divided into two groups， with 11 cases in the recurrent pneumonia group and 108 cases in the non-recurrent pneumonia group. Relevant clinical data were compared between the two groups， including the general basic information of the recipient （gender， age， height， weight， smoking history，etc.）， as well as the relevant clinical data （the time of dialysis before kidney transplantation， the maintenance treatment plan of immunosuppressant after surgery， whether there was delayed recovery of kidney function after transplantation， whether there was a decrease in white blood cells after transplantation， serum creatinine level at discharge， whether there was diabetes before and after surgery， and whether there was viral hepatitis B infection， etc.）. We conducted univariate analysis and multivariate logistic regression analysis to explore the risk factors for recurrent pneumonia in elderly kidneytransplant recipients after surgery. Results The incidence of recurrent pneumonia in elderly kidney transplant recipientsafter surgery was 9.24% （11/119）， and one patient in the case group died from severe pneumonia， with a mortality rate of 9.1% （1/11）. Smoking history （OR ＝ 13.15，95% CI ＝ 2.406 ～ 71.91，P ＝ 0.003） and postoperative leukopenia （OR ＝ 6.050，95% CI ＝ 1.248 ～ 29.32，P ＝ 0.025） were risk factors for recurrent pneumonia in elderly kidney transplant recipients. Conclusion Smoking history and postoperative leukopenia increase the risk of recurrent pneumonia in elderly kidney transplant recipients. So we should strengthen postoperative health education for elderly kidney transplant recipients， encourage smoking cessation， and prevent and treat postoperative leukopenia. 

Objective Establish model of abdominal heterotopic heart transplantation in mice and summarize the experience to provide animal model support for further study of organ transplantation immunology. Methods Inbred BALB/c（n ＝ 30）and C57BL/6（n ＝ 30）mice were selected as donors，and inbred BALB/c（n ＝ 60）mice were used as recipients. The ascending aorta of the donor was anastomosed to the abdominal aorta of the recipient，and the pulmonary artery of the donor was anastomosed to the inferior vena cava of the recipient respectively to establish the heterotopic heart transplantation model. The survival time and the rejection of grafts were observed postoperatively. Results The successful rate of transplantation was 85%（51/60）. The donoroperation time was（7.0±1.0）min，and the recipient operation time was（60±10）min. The vascular anastomosis time was（25±3.0）min. After the transplantation，no immunosuppressive agent was used，and the survival time of the graft was（7.6±0.9）d. The graft on the fifth day，the seventh day showed typical rejection by histopathology. Conclusion Skilled microsurgical techniques and timely management of surgical complications are key to the successful establishment of abdominal heterotopic heart transplantation in mice. 

 Objective To elucidate the relationship between preoperative immunotherapy，the abundance of tertiary lymphoid structures（TLS）in hepatocellular carcinoma（HCC）tissues，and to evaluate patient prognosis following liver transplantation. Methods The clinical data of 149 liver transplant patients with liver cancer at Huashan Hospital Affiliated to Fudan University from January 2018 to December 2023 were retrospectively analyzed. Pathological slides of each patient were scored for TLS. Patients were categorized into four groups based on downstaging treatment outcomes ：those initially meeting the Milan criteria（n ＝ 35），those exceeding the Milan criteria without downstaging treatment（n ＝ 38），successful downstaging cases（n ＝ 33），and unsuccessful downstaging cases （n ＝ 43）. Kaplan-Meier analysis and the log-rank test were employed for survival analysis. The correlation betweenimmunotherapy and TLS abundance was assessed using non-parametric statistical methods. Results Survival analysis of the overall cohort revealed that patients with high intratumoral TLS abundance had significantly higher recurrence-free survival（RFS）than those with low TLS abundance（P ＜ 0.05）. Among patients receiving downstaging treatment，the recurrence risk in the successful downstaging group was significantly lower than in the unsuccessful group（P ＜ 0.05）. Non-parametric testing of the successful downstaging group demonstrated that preoperative immunotherapy significantly increased intratumoral TLS abundance（P ＜ 0.05）. Similarly，nonparametric testing of all patients receiving immunotherapy showed a statistically significant increase in intratumoral TLS abundance in the successful downstaging group（P ＜ 0.05）. Conclusion Successful downstaging withpreoperative immunotherapy improves the prognosis of HCC patients undergoing liver transplantation，potentially by enhancing intratumoral TLS abundance. 

Objective To understand the status and hot spots of the research on the health management of kidney transplantation recipients in China，to discuss the research deficiencies and development trends，andto provide reference for the development of this field. Methods The relevant literatures were retrieved from CNKI，Wanfang，Weipu and China Biomedical database on August 8，2023，and visualized with CiteSpace and VOSviewer. Results A total of 678 Chinese literatures were retrieved，the number of which showed anincreasing trend. The published journals were concentrated，and the cooperation between authors and institutions was limited and regional. Research hotspots included medication compliance，self-management，quality of life，social support，the frontier areas include telemedicine，life-cycle follow-up management，and evidence-based nursing. Conclusion The study on the health management of kidney transplant recipients has gradually changed from passive health education to active health promotion，but the research force still needs to be strengthened. It is recommended to apply telemedicine and evidence-based concepts，improve the follow-up management system，andstrengthen the follow-up management of the whole life cycle. 

Objective To summarize the experience in the treatment of antibody mediated rejection（AMR）after kidney transplantation. Methods A retrospective analysis was conducted on kidney transplant recipients who was diagnosed as AMR by biopsy in the Third Medical Center of the General Hospital of the People's Liberation Army from 2018 to 2021. Regular follow-up and prognosis were analyzed after treatment. The survival time of the graft between different time of rejection after transplantation，pathological type，DSA type，and number of kidney transplants were compared，and factors that may affect prognosis were preliminarily screened. Results The results showed that 14 recipients were diagnosed with AMR. After combination therapy of plasma exchange，lymphocyte depleting antibody and immunoglobulin treatment，the overall 1-year graft survival rate was 78.6%，and the 5-year survival rate was 43%. Within 6 months after treatment，3 cases with infection required hospitalization，including 1 case of cutaneous herpes zoster infection，1 case of urinary tract infection，and 1 case of diarrhea. There were nolife-threatening or graft loss case directly related to infection. Conclusion A combination treatment based on plasma exchange can achieve some effects in the treatment of antibody mediated rejection after kidney transplantation. Further research is needed on the optimization of protocols for different types of rejection. 

Objective To retrospectively summarize the perioperative clinical data of patients with endstage pulmonary arterial hypertension undergoing lung transplantation， and to analyze the recovery of cardiac function after surgery. Methods A retrospective analysis was conducted on six patients with end-stage pulmonary arterial hypertension who underwent lung transplantation at the Department of Lung Transplantation of ChinaJapan Friendship Hospital from March 2017 to June 2024. The general information of the patients before surgery， preoperative cardiac function， perioperative use of ECMO and IABP， and the recovery of cardiac function after surgery were analyzed. Results Among the six patients， three were male， and the median age was 33.5 years old. Four patients were diagnosed with idiopathic pulmonary arterial hypertension， and two had Eisenmenger's syndrome. All patients underwent a detailed cardiac function assessment before surgery. All six patients underwent double lungtransplantation with VA-ECMO assistance. The duration of ECMO assistance was 2 ～ 7 d， with a median time of 4 d. Two patients used IABP. Three patients developed left heart dysfunction after the surgery. But after effective treatment， all patients' cardiac function recovered during the perioperative period. Postoperative echocardiographic results showed that the relevant indicators of cardiac function of all the patients returned to normal， with statistically significant differences compared to preoperative levels（ P ＜ 0.05）. Conclusion Double lung transplantation is the last treatment option for patients with end-stage pulmonary arterial hypertension. Perioperative circulatory support measures， such as VA-ECMO and IABP， are beneficial for the recovery of cardiac function in such patients. 

Objective To explore whether temperature changes at different times in the perioperative period correlate with the incidence of early allograft dysfunction（EAD）. Methods Recipients who underwent liver transplantation in the Eastern Theater General Hospital between December 1，2020， and November 30，2023 wereselected， and perioperative clinical data and temperature data at different times of the recipients were collected， andmeaningful body temperature was identified by propensity score matching with other general information data to analyze the correlation of early graft insufficiency with temperature changes. Results There were 86 cases of EAD among 272 recipients， with an incidence of 31.2%. After 1 ：1 propensity score matching， a total of 56 pairs of recipients were matched: divided into the EAD group （n ＝ 56 cases）， and the NO-EAD group （n ＝ 56 instances）. The temperature change 1 h after the opening of the inferior vena cava in the neo-hepatic phase （△ T4 ） was significantly different between the two groups （t ＝ 2.382，P ＝ 0.019）， and with the optimal truncation value of the ROC curve 0.45 ℃， it was foundthat the incidence of EAD in recipients with △ T4lower than 0.45℃ was 2.901 times higher than that higher than 0.45℃（95% CI ＝ 1.181 ～ 7.125，P ＝ 0.020）. Conclusion Temperature change 1 h after opening of the inferior vena cava in the anhepatic phase has a certain correlation with the early graft insufficiency， and the faster the body temperatureincreases， the earlier the early graft function recovers. The quicker the body temperature rises to its normal temperature，the lower the incidence of early graft insufficiency. Intraoperative temperature changes can reflect the recovery of newliver function at an early stage， and the poor rise of body temperature in the new liver stage should arouse the vigilance of clinicians. 

Objective To investigate the care burden of family caregivers of liver transplant recipients andto explore its influencing factors. Methods Convenience sampling method was used to select the family caregivers of liver transplant recipients who visited the Organ Transplantation Center of Qingdao University Affiliated Hospital from June 2022 to December 2022 as the research subjects. A total of 205 family caregivers of adult liver transplant recipients wereselected by convenience sampling method and investigated with the General Information Questionnaire ： Zarit CaregiverBurden Interview（ZBI）. Results The score of caregiver burden of liver transplant recipients was （28.84±14.33）， and67.8% of them had moderate and severe level of caregiver burden. Univariate analysis showed that there were statisticallysignificant differences in the level of care burden between liver transplant recipients with postoperative complications and their self-care ability， family caregivers with other diseases， family monthly income， daily care time and total caring time （P ＜ 0.05）. Multiple linear regression results showed that the self-care ability of liver transplant recipients and whetherfamily caregivers had other diseases were the influencing factors of care burden （P ＜ 0.05）. Conclusion The familycaregivers of liver transplant recipients have a certain degree of care burden. While providing nursing care for recipients，medical staff should also pay attention to their family caregivers and take timely targeted interventions to reduce the careburden and improve the overall quality of life. 

Objective To investigate the role of fission protein 1 （FIS1） in affecting renal ischemiareperfusion injury by regulating mitochondrial division and apoptosis. Methods Probing FIS1 expression levels and apoptosis levels were measured at different times in the renal tubular epithelial cell（ HK-2）with hypoxiareoxygenation（ HR）model and mouse renal ischemia-reperfusion（ IR） model. Cell lines with FIS1 knockdown and overexpression were constructed，changes in the degree of mitochondrial division were observed using mitochondrial probes，and changes in the level of apoptosis were detected with flow cytometry. Results FIS1 knockdown/ overexpression had essentially no effect in normal cells. After HR， knockdown of FIS1 inhibited mitochondrial division and reduced apoptosis levels， and vice versa after overexpression of FIS1. Conclusion In IRI， Inhibition of FIS1 expression reduces mitochondrial division and reduces the level of apoptosis， which is expected to be a potential therapeutic target for IRI. 

Objective To investigate the effects of dexmedetomidine intervention on procalcitonin（PCT）， tumor necrosis factor - α（TNF - α）， helper T cell （Th17） levels， and cognitive function in patientswith decompensated cirrhosis undergoing liver transplantation surgery. Methods A total number of 72 patientswho underwent liver transplantation surgery due to decompensated cirrhosis and were treated in Shenzhen Third People's Hospital from November 2022 to November 2023 were randomly divided into a study group （D group，n ＝ 36） and a control group （NS group，n ＝ 36）. The D group received intravenous infusion of dexmedetomidine loading dose after entering theroom and maintained it until the end of the surgery， while the NS group received an equal dose of physiological saline. Basic vital signs， including mean blood pressure （MAP）， heart rate （HR），pulse oxygen saturation（SPO2 ），cardiac output（CO），and central venous pressure （CVP），5 mins before anesthesia （T1 ），5 mins after tracheal intubation （T2 ），5 mins before surgery （T3 ），5 mins before anhepatic phase （T4 ），5 mins before anhepatic phase （T5 ），5 mins before new liver phase （T6 ）， 5 mins after new liver phase （T7 ）， and at the end of surgery （T8 ）. Changes in PCT， TNF - α， and Th17 levels between two groups of patients at 24 h before surgery，24 h after surgery， and 72 h after surgery， as well as the incidence of secondary infections at 15 d after surgery were compared. At the same time， the cognitive function of the two groups of patients was evaluated using the Montreal Cognitive Assessment Scale （MMSE）24 h before and 72 h after surgery， and the total amount of vasoactive drugs during surgery，intensive care unit （ICU） stay time after surgery， and total length of hospital stay after surgery were compared between the two groups of patients. Results Compared with the NS group， there was no significant difference in basic vital signs at all time points in the D group. The PCT and Th17 levels were lower in the D group at 24 and 72 h after surgery （P ＜ 0.05）. The level of TNF - α was lower at 24 h postoperatively （P ＜ 0.05）， but there was no difference at 72 h. On postoperative day 15， there was no significant difference in the incidence of secondary infections between group D （5/36，13.89%） and group NS （7/36，19.44%）（P ＞ 0.05）. In terms of cognitive function assessment， there was no significant difference in MMSE scores between the two groups before surgery （P ＞ 0.05），and the MMSE score in group D was higher than that in group NS at 72 h after surgery （P ＜ 0.05）. Concusion The use of dexmedetomidine during general anesthesia can effectively reduce the levels of PCT， TNF - α， and Th17 after liver transplantation in patients with decompensated cirrhosis， and alleviate inflammatory reactions. Meanwhile，dexmedetomidine can also improve postoperative cognitive function. These results suggest that dexmedetomidine has potential clinical value in the prognosis of liver transplantation in the decompensated phase of hepatitis cirrhosis.

Objective To develop a human liver splitting model with disease using normothermicmachine perfusion. Methods A liver from a liver transplant patient with acute-on-chronic liver failure and hepatitis B cirrhosis was split into left and right lobes，and the hepatic artery and portal vein of each half were respectively connected to two separate perfusion system for normothermic machine perfusion. Pressure and flow were continuously monitored during perfusion，and perfusate samples were collected for blood-gas analysis toassess the function of the diseased liver. Results Both lobes of the graft were successfully perfused in vitro for 16 h. Throughout this period，the pressure，flow，and other parameters of perfusion remained stable. The blood-gas analysis results of the perfusate were maintained within the physiological range. Conclusion We have successfully established a splitting perfusion model of diseased liver after liver transplantation that mimics human physiological and pathological conditions. This model allows for the detailed study of liver function under conditions that closelyapproximate human physiology. 

Objective Post-renal transplantation anemia（PTA）occurs frequently in kidney transplant recipients，significantly impacting their quality of life and graft loss. Currently，effective methods to predictthe risk of persistent PTA early post-transplantation are lacking. This study aimed to develop a nomogram prediction model for early persistent PTA specifically tailored to kidney transplant recipients. Methods Using the electronic medical record system of Southern Hospital of Southern Medical University，patient data from January 1，2020 to December 31，2022 were obtained，and 245 subjects were ultimately selected as the research subjects. Among these，85% were randomly selected as the training set for model development，and the remaining 15% constituted the testing set. Using the Least Absolute Shrinkage and Selection Operator（Lasso）regression model，variables potentially affecting early persistent PTA were screened to identify predictive factors.A logistic regression analysis was employed to establish the prediction model. Model performance was assessed using Receiver operating characteristic（ROC）curves，area under the curve（AUC），Calibration plots，and decision Curve Analysis（DCA）. Results Identified predictive factors after screening included recipient's preoperative body mass index，preoperative serum albumin level，preoperative hemoglobin level，preoperative mean corpuscular volume，perioperative use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers，exogenous iron supplementation，and exogenous erythropoietin supplementation. The model demonstrated good discriminativeability with an AUC of 0.87 for the training set and 0.75 for the testing set，indicating robust predictive performance. Calibration and DCA further confirmed the accuracy and clinical utility of the model. Conclusion This nomogram prediction model utilizes early recipient information，including demographic characteristics，laboratory data，and medication regimens，to accurately predict individualized risk of early persistent PTA in kidney transplant recipients. This provides a basis for early clinical intervention，potentially improving patient prognosis and quality of life. 

Objective To establish an ex situ machine perfusion（MP）system for long-term liverperfusion using normothermic machine perfusion（NMP）technology. Methods A porcine liver was connectedto the Life-X100 perfusion system for normothermic machine perfusion. Perfusion parameters and perfusate blood-gas analysis results were continuously monitored during the perfusion process to assess the ex situ liverfunction. Results The porcine liver was successfully perfused ex situ for 138 hours，with stable perfusionparameters and well-maintained liver function. Conclusion We have preliminarily established an ex situ longterm liver perfusion system. This system can be used for the ex situ maintenance of human livers in the future and can serve as a basis for various exploratory studies to advance medical development in our country.