Objective This study focuses on the effect of anti HLA- Ⅱ antibody on kidney function andlong-term survival of kidney transplantation patients. Methods A total number of 107 kidney transplantationpatients from Capital Medical University Affiliated Beijing Friendship Hospital, whose anti HLA class Ⅱ antibodies had been detected to be positive and transplantation operation had been performed in 2007. In 2010-2011, these patients’HLA class Ⅱ antibodies were detected again. In October 2014, these patients were detected for renalfunction and long-term survival. Results The detection results in 2007 showed that 107 kidney transplantationpatients had positive anti HLA- Ⅱ antibody. 19 patients had normal renal function with positive anti HLA- Ⅱantibody in the detection of 2010 and 2011, and normal renal function in 2014. 43 of these patients had normal renal function but their HLA class Ⅱ antibodies turn to be negative in 2010-2011，and they had normal kidney function in 2014. There were 2 of these patients who had normal renal function with negative antibody in 2010-2011, but their renal function reduced in 2014. There were 3 patients who had renal function reduced in 2010-2011 with negative antibody，but their renal function didn’t show downward trend in 2014. A total number of 18 patients lost most renalfunction in 2010-2011 with positive anti HLA- Ⅱ antibody, and lost renal function in 2014. 22 patients lost renalfunction or lost contact 2-3 years after renal transplantation. Conclusion The effects of anti HLA- Ⅱ antibodies on renal allograft vary from different person, and protective antibodies may exist.

Objective To investigate the risk factors of IgA nephropathy recurrence after kidney transplantation. Methods A total of 149 kidney failure patients with primary IgA nephropathy who received kidney transplantation at the Organ Transplantation Center of Zhengzhou People's Hospital from January 2008 to December 2019 were selected as the study subjects. According to the results of the protocol kidney biopsy，the recipients were divided into the recurrent group（40 cases）and the non-recurrent group（109 cases）. Gender，age，donor type，dialysis duration，progression to end-stage renal disease（ESRD），history of transplantation，historyof hypertension and diabetes，history of postoperative infection，immunosuppressive regimen，HLA mismatchnumber，and risk factors for postoperative recurrence were recorded in the two groups. Results Compared withthe non-recurrent group，there were no statistically significant differences in gender，number of kidney transplants，diabetes，hypertension，immunosuppressive regimen，postoperative infection history，dialysis time between the two groups（P ＞ 0.05）. Logistic analysis showed that donor origin，recipient age and HLA mismatch were the risk factors for IgAN recurrence after renal transplantation，and the differences were statistically significant（All P ＜ 0.05）. Conclusion The recurrence of IgA nephropathy after kidney transplantation was related to the source of donor，recipient age and HLA mismatch. Intervention measures should be taken according to the above factors to provide ideas for clinical control of IgAN recurrence. 

Objective To analyze the results of the determination of Tacrolimus（Tac）concentration in wholeblood by chemiluminescent microparticle immunoassay and latex enhanced immunosuppression. Methods The whole blood concentration of tacrolimus in 96 renal transplant recipients was parallelly measured by chemiluminescentmicroparticle immunoassay and latex enhanced immunosuppression, the results of different tests were compared and the correlation and regression were analyzed. Results The concentration of tacrolimus measured bychemiluminescent microparticle immunoassay（5.78 ± 2.18）μg/L was lower than that measured by latex enhanced immunosuppression（6.51±2.32）μg/L, and the difference was statistically significant（P ＜ 0.001）. There was a significant positive correlation between the two methods（r ＝ 0.9676，P ＜ 0.0001）, besides, the results of the twomethods were in accordance with the linear regression equation Y ＝ 0.551+1.032X（X was the chemical radio-particle immunoassay, Y was the latex enhanced immunosuppression）. Conclusion There was a good correlationbetween the two methods, but due to the significant  difference, comparison between each other cannot be made. The two methods can be calculated by linear regression equation. It is suggested that the same method should be selected for the same patient to monitor the whole blood concentration of tacrolimus in the long run, so as to provide accurate and reliable basis for clinical individual drug application.

Objective To investigate the nocturia and its impact on the quality of life in the non-eldlymale patients after successful renal transplantation and to explore the related risk factors and causes which led tonocturia. Methods We designed a patient-completed questionnaire according to the characteristics of clinicalrecords，international prostate symptom score（IPSS）and quality of life score. We distributed the questionnairesand instructed them to fill in the meetingspot of kidney transplant friends. Results A total of 182 questionnaires were distributed and 120 were collected，only 90 cases meet the requirements of the study. The prevalence of nocturia（awakening at night twice or more to void）were 61 cases（67.8％）. Seventy-six cases（84.4％）of all patients were satisfied with the quality of life after renal transplantation. There was no statistically correlation betweenurine output before transplantation（24 hours），the total time of hemodialysis before operation，24 hours fluid intake now，the total time after operation and nocturia（all P ＞ 0.05）. Conclusions Nocturia was very prevalent in the non-eldly male patients after successful renal transplantation. This research demonstrated that nocturia may be caused by many risk factors interactions and did not bring an obvious adverse impact on the quality of life after successfulrenal transplantation．

Objective To summarize the therapeutic efficacy of liver transplantation in patients with intrahepatic cholangiocarcinoma（ICC）and to analyze the prognostic risk factors. Methods The clinicopathological data of 46 pathological confirmed ICC patients who underwent liver transplantation in Zhongshan Hospital Affiliated to Fudan University from April 2001 to February 2022 were analyzed retrospectively. The survival and recurrence of the patients were followed up. Kaplan Meier method was employed to analyze the overall survival（OS）rate and relapse-free survival（RFS） rate of patients，and Cox regression model was used to evaluate the risk factors affecting the prognosis. ResultsThe median overall survival time of patients with ICC after liver transplantation was 19 months，and the 1，3，5-year OS rates were 64.4%，30.2%，20.7%，respectively. The median RFS time was 10 months，and the 1，3 and 5-year RFS rates were 45.8%，20.8%，10.4%，respectively. The results of multivariate analysis revealed that the level of preoperative carbohydrate antigen19-9（CA19-9）（P ＝ 0.026）was an independent risk factor for the overall survival time of patients，and local extrahepatic structures due to direct ICC invasion（P ＝ 0.019）was an independent risk factor for tumor recurrence and metastasis. Conclusion The prognosis of liver transplantation for intrahepatic cholangiocarcinoma is poor. The high level of preoperative CA19-9 is an independent risk factor for short postoperative survival of recipients，and direct tumor invasion of extrahepatic tissues is an independent risk factor for high recurrence rate after liver transplantation. 

Objective To evaluate the efficacy and safety of bicyclol treatment in drug-induced liver injuryafter renal transplantation. Methods A retrospective analysis was performed on 36 cases of renal transplantation， who experienced drug-induced liver injury 3 months after transplantation from January 2010 to August 2013 in Second People's Hospital of Shanxi Province. 22 cases from October 2011 to August 2013 were served as test group （treated with bicyclol 25 mg/50 mg）, while 14 cases from January 2010 to September 2011 as control group（treated with capsule of Gan Caosuaneran 150 mg）. The patients in two groups received treatment 3 times per day for 4 weeks.Before and 4 weeks after treatment, the changes in alanine aminotransferase（ALT）, aspartateaminotransferase （AST）, total bilirubin（TBil）and serum creatinine（SCr）were recorded，as well as 50% decreased time and restore tonormal time of ALT. Adverse reaction induced by drugs was observed. Results ALT，AST and TBil after treatment in both groups were significantly lower than those before treatment（all P ＜ 0.05），but there was no significant change in SCr. There were no significant differences in above indexes before and after treatment between two groups （all P ＞ 0.05）. The average time of 50％ decrease in ALT and the time of return to normal in test group were significantly shorter than those in control group〔time of decreased 50％（days）：5.30±2.26 vs. 11.00±5.36，timeof return to normal（days）：7.60±4.71 vs. 16.00±9.71，both P ＜ 0.05〕. During treatment，there was no rejectionor drug-related adverse reaction in both groups. Conclusion The efficacy of bicyclol treatment on drug-induced liver injury after renal transplantation is precise，safe，and easy to use。

Objective To explicit the characteristics and influencing factors of tacrolimus blood concentration in early postoperative stage of liver transplantation recipients, and to provide a basis for individualized treatment. Methods Whole blood trough concentrations of tacrolimus were analyzed in 14 days post livertransplantation in 87 recipients. Using C0/D/W as the dependent variable, the recipient demographic factors, liverand kidney function, CYP3A5 genotype and combined therapy with calcium channel blockers were considered as independent variables, the influencing factors of tacrolimus blood concentration were analyzed by multivariate stepwise regression method. Results Variability of tacrolimus blood concentration was significant and 47.1% of the recipients could not reach the target range in the first 14 days post transplantation. Recipient body weight, hematocrit, CYP3A5 genotype, albumin, combined use of calcium channel blockers, alanine aminotransferase were factors influencing the blood concentration of tacrolimus in the early postoperative period. Conclusion The blood concentration of tacrolimus in the early stage post liver transplantation is affected by many factors. The clinical pharmacist should work closely with the clinical doctor to comprehensively consider various influencing factors and formulate a more reasonable individualized treatment plan.

Objective To observe the efficacy and safety of T lymphocyte polyclonal antibody in deceased donor （DD）kidney transplantation. Methods The clinical data of 324 renal transplant recipients who met the research criteria from August 20，2015 to February 28，2020 in our hospital were retrospectively analyzed. They were divided into two groups. A total number of 147 patients were treated with rabbit anti humanthymocyte immunoglobulin（rATG）（group A）. 177 patients were treated with anti human T lymphocyte rabbit immunoglobulin （ATG-Fresenius）（group B）. The acute rejection （AR）， delayed graft function （DGF），lung infection， bone marrow suppression and cytomegalovirus （CMV） infection were compared between the two groups. Results The incidence of AR in group A and group B was 32.65% and 16.94% respectively （P ＜ 0.05）. There were 17 cases of AR in group A（17/48）and 23 cases in group B（23/30）within one month after operation（χ2 ＝ 12.573 7，P ＜ 0.01）. The incidence of AR in group A was lower than that in group B （P ＜ 0.01）. Theincidence of DGF was 25.17% （37/147）in group A and 12.42% （22/177）in group B （P ＜ 0.01）. Thirty days after operation，the incidence of DGF in group A was lower than that in group B（P ＜ 0.01）.There was no significant difference in the adverse events of bone marrow suppression，pulmonary infection andCMV infection（P ＞ 0.05）. Conclusion In our hospital，both rATG and ATG-F can be safely and effectively used in the induction and postoperative treatment of DD renal transplantation. The rATG has a better performance in correcting the DGF and reducing the incidence of AR in DD kidney transplantation.

Objective To investigate the incidence of Epstein-Barr virus（EBV） infection after pediatricliving related liver transplantation and analyze related treatment and prognosis. Methods The medical records of pediatric liver transplant recipients who received living related liver transplantation because of biliary atresiaand biliary cirrhosis in Tianjin First Center Hospital during January 1，2012 and December 31，2013 wereanalyzed retrospectively，with diagnostic standard of positive blood EBV-DNA. The incidence of Epstein-Barr virus infection after pediatric living related liver transplantation and corresponding treatment and prognosis were analyzed. Results 14（16.3%）out of 86 pediatric liver transplant recipients were turned out to be EBV-DNApositive in blood，which were defined as EBV infection，9 cases occurred within the first 3 months after transplantation and 5 after 3 months；when therapy of reducing immunosuppressants and multi antivirus drugs were applied，a total of 13 recipients acquired favorable prognosis，and one case may turn into chronic EBV infection. Conclusion When appropriate immunosuppressants adjustment and antivirus drugs were applied，most pediatric liver transplant recipients who developed EBV infection can acquire satisfying prognosis.

Objective Preliminary study on the repair effect of normothermic mechine perfusion（NMP）on acute kidney injury（AKI）of kidneys from cardiac death donors. Methods In vitro continuousNMP was used for cardiac-death pig kidneys . The blood gas biochemical indexes of the perfusion fluid and urine as well as the kidney pathological indexes during perfusion were recorded and analyzed. Results Ten pig kidneys were perfused with NMP in this study，of which 9 were perfused with single kidney，and 1 was perfused combined with liver. After the perfusion started，the kidneys were filled quickly and the surface tension was rich. About 5 min after the perfusion，the kidneys became bright red. The urine output of the kidneys increased at the initial stage of perfusion，reached the extreme value at（3.2±1.5）h on average after perfusion，and then decreased slowly. About 6 h later，the appearance of the kidneys turned dull color. The cross-section of the kidneys showed obvious hemorrhage in the renal pelvis and calyx，and the renal cortex and medulla were slightly bloody with soft and loose appearance. The normal perfusion flow rate increased gradually，reached peak after 2 ~ 3 hours of perfusion，and then maintained at a stable level. PaO2 was basically maintained in the range of 350 ~ 450 mmHg（1 mmHg ＝ 0.133 kPa）；PaCO2 varied greatly among the groups，mostly fluctuating at 15 ~ 60 mmHg，while each of perfusion individuals maintained a relatively stable level. The Na+ concentration fluctuated slightly in the early process of perfusion，and reached a stable level after about 3 ~ 4 h and was close to the normal value range. The K+ and Ca2+ concentrations were fluctuated within the physiological range. The lactic acid level of single-kidney perfusion increased progressively，while the lactic acid level of kidney-liver combined perfusion gradually decreased and then stabilized at a low level. The cross-section of the kidneys showed no obvious bleeding in the renal pelvis and calyx after 9 h of liver-kidney combined perfusion，and the renal cortex and medulla were bloodless and normal in appearance. The H&E pathological results showed that the damage of the globules and tubules gradually and slowly increased during the perfusion process，which suggested that the Normothermic Mechine Perfusion might delay the progress of the globular and tubule damage. Conclusion NMP can provide an environment close to the physiological state for isolated kidneys，and may have a certain repair effect on AKI. Therefore，NMP is expected to expand the source of donor kidneys and increase the rate of kidney transplantationin patients with end-stage renal disease for better prognosis and quality of life. In addition，liver-kidney combinedperfusion had better renal appearance and lactic acid levels than single-kidney perfusion，but no advantage in perfusion time，urine output，and pathological results. Above conclusions need to be supported by further large sample research.

Objective The addition of insulin therapy to transient expression of the transcription factor（pancreatic and duodenal homeobox gene1，PDX-1） may enable islet regeneration in the pancreas of diabetic mice. Methods Diabetes was induced in C57BL/6J mice（BG ＞ 16.7 mmol/L） by streptozotocin intraperitoneal injection（200 mg/kg）. Gene transfer was then performed by intra-pancreatic injection of an adenoviral vector （1×109 pfu）encoded witheither PDX-1（Ad-PDX-1） or LacZ （Ad-LacZ） control， followed by daily insulin administration. Body weight， blood glucose，and pancreas histology were monitored. Results Our results showed that insulin administration gradually decreased blood glucose level in Ad-Pdx1 group， which became euglycemic （BG ＜ 11.1 mmol/L） and insulin-independent in about two to three weeks. Without insulin， however, no obvious effect was observed. The animals in the Ad-LacZ control group （with or without insulin therapy）remained hyperglycemic throughout the 30 days study course. Histological analysis showed that newly formed islets consisting solely of insulin-producing cells were induced in the pancreas of the mice treated with both insulin and Ad-PDX-1, while no or very few insulin positive cells were observed in control. Conclusion Transient expression of PDX-1 combined with insulin treatment effectively induced the regeneration of functional islet β cells in the pancreas of the diabetic mice， forming new islet and reversing diabetes. This approach may prove to be a novel strategy for the treatment of diabetes.

Objective To study the therapeutic effect of avatrombopag on severe thrombocytopenia（TCP）in patients waiting for liver transplantation. Methods This study was conducted by analyzing the clinical data of67 patients waiting for liver transplantation with severe TCP in the First Affiliated Hospital of Zhengzhou Universityfrom February 2021 to October 2022. The general information of patients and their platelet count before and afteravatrombopag treatment were collected in this study. Patients were divided into two groups for further analysisaccording to whether recombinant human thrombopoietin（rhTPO）was used at same time. Platelet count no less than 50×109 /L after treatment of avatrombopag was considered as effective response. Results The platelet count of67 patients waiting for liver transplantation with severe TCP was significantly elevated after using avatrombopag（P＝ 0.001）. Moreover，the platelet counts of 89.55%（60/67）patients were higher than 50×109 /L and there was no significant difference in the effective rate between different thrombocytopenia groups（P ＝ 0.373）. Furtheranalysis showed that combined therapy group（avatrombopag and rhTPO）acquired significant higher platelet count than monotherapy group（P ＝ 0.002）with similar basal count level before treatment（P＝ 0.064）. Furthermore，the percentage of patients whose platelet counts were more than 50×109 /L had no significant difference（P ＝ 0.228）between avatrombopag group 85.00%（34/40）and combined group 96.30%（26/27）. Conclusion Avatrombopag could increase the platelet level in severe TCP patients waiting for liver transplantation. Avatrombopag combined with rhTPO may have better therapeutic effect.