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 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 observe the efficacy and survival status of single donor kidney transplantation with high Remuzzi score at zero-point biopsy. Methods A retrospective analysis was conducted on 178 recipients of single donor kidney transplantation who received deceased organ donation at the Second People's Hospital of Shanxi Province from January 2018 to January 2021. The donor kidneys underwent zeropoint biopsies and were evaluated with pathological Remuzzi scoring. The recipients were divided into high scoring group（≥ 4 and ≤ 6）and low scoring group（≤ 3）. The occurrence of delayed graft function of transplanted kidneys，postoperative renal function，occurrence of proteinuria，and survival of recipients and transplantedkidneys in both groups were observed with a follow-up time of 36 months. Results There were no statisticallysignificant differences（P ＞ 0.05）in gender ratio，body mass index，human leukocyte antigen（HLA）mismatch number，and donor kidney cold ischemia time between the two groups of recipients; there was no statistically significant difference in baseline blood creatinine and glomerular filtration rate before surgery（P ＞ 0.05）. A total number of 21 cases（23.6%）in the high scoring group experienced delayed graft function of transplanted kidneys after surgery，while 6 cases（6.7%）in the low scoring group experienced delayed graft function. The difference between the two groups was statistically significant（P ＜ 0.05），24 cases（27%）in the high scoring group developed proteinuria after surgery，while 9 cases（10.1%）developed proteinuria in the low scoring group. Through multiple factor analysis，it was found that the occurrence of proteinuria after kidney transplantation and the addition of mTOR immunosuppressants after surgery （OR ＝ 4.52， P ＜ 0.05）were related to thepreoperative Remuzzi score（OR ＝ 1.46，P ＜ 0.05）. At a follow-up of 36 months，the high scoring group had a blood creatinine level of（131.3±5.53）μmol/L and an eGFR level of（62.9±2.02）ml/（min · 1.73 m2 ）， while the low scoring group had a blood creatinine level of（121.3±2.18）μmol/L and an eGFR level of（65.0± 1.24）ml/（min·1.73 m2 ）. There was no statistically significant difference between the two groups（P ＞ 0.05）. Thesurvival rate of recipients in the high scoring group 36 months after surgery was 95.5%（85 cases），and the survival rate of transplanted kidneys was 95.5%（85 cases）. The survival rate of recipients in the low scoring group was 95.5% （85 cases），and the survival rate of transplanted kidneys was 97.7%（87 cases），with no statistically significant difference（P ＞ 0.05）. Conclusion Single kidney transplantation with a pre-transplant renal biopsy score of 6 ≥ Remuzzi ≥ 4 can achieve good long-term kidney survival and is worthy of clinical implementation. 

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 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 investigate the characteristics of major histocompatibility complex class Ⅰ associated chain A （MICA） antibody in recipients after renal transplantation and its relationship with the pathological status of the transplanted kidneys. Methods The data of 355 patients from the Department of Kidney Transplantation at the First Affiliated Hospital of Xi'an Jiaotong University from January 2016 to December 2023 were retrospectively analyzed. According to the pathological diagnosis results of the transplanted kidneys， they were divided into rejection group（ 76 cases）， non-rejection group（ 54 cases）， and stable renal function group （225 cases）. Statistical analysis was performed using GraphPad Prism 9.0 statistical software. Results Among 355recipients， 18.3%（ 65 cases） were positive for MICA antibodies， and there was no correlation with HLA antibodies （r ＝ -0.202 7，P ＝ 0.1980）. There were significant differences in common MICA antibodies between rejection group，non-rejection group and stable renal function group. The multiples of MFI and threshold of MICA antibody in the rejection group were generally higher than those in the non-rejection group and the renal function stable group， especially MICA*009， MICA*004 and MICA*002（ P ＜ 0.000 1）. Receiver operating characteristic curve（ ROC） analysis found that MICA antibody has high diagnostic value in predicting interstitial inflammation〔（area under curve）AUC ＝ 0.8201〕and angiitis（ AUC ＝ 0.814 1） in acute renal allograft lesions，interstitial fibrosis（AUC ＝ 0.819 7） and tubular atrophy（ AUC ＝ 0.839 9） in chronic renal allograft nephropathy. The ability to predict antibodymediated rejection（ ABMR） was stronger than that of T-cell-mediated rejection（ TCMR）（ overall rejection ： AUC ＝ 0.688 5 ；ABMR ： AUC ＝ 0.603 8 ；TCMR ： AUC ＝ 0.542 3）. Conclusion The MICA antibody was different in rejection， non-rejection and stable renal function recipients after renal transplantation. MICA antibody has high value in predicting tubulointerstitial disease in transplanted kidneys， and its value in predicting ABMR is higher than that in predicting TCMR. 

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 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 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 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 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.