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 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. 

Objective To study the pathomorphological characteristics of extrahepatic portal vein wallthickening in children with biliary atresia, and to investigate the clinical significance and risk factors of the degree of extrahepatic portal vein wall thickening. Methods The clinicopathological data of 60 pediatric liver transplant recipients with biliary atresia from Children's Organ Transplantation Department of Tianjin First Central Hospital in June 2022 to December 2022 were analyzed. The pathomorphological changes of extrahepatic portal vein wall thickening in children with biliary atresia were observed. According to the median thickness of the total wall of extrahepatic portal vein, children with biliary atresia were divided into mild portal vein thickening group and severe portal vein thickeninggroup. The survival time of native liver after Kasai operation was compared between the two groups. Univariate and multivariate logistic regression were used to analyze the influencing factors of the degree of extrahepatic portal vein wallthickening. Results The wall of extrahepatic portal vein in children with biliary atresia was thickened to varyingdegrees， and the main pathological changes were interstitial edema under vascular endothelial cells， proliferation of fibers and fibroblasts， and a small amount of inflammatory cell infiltration. The intimal thickness of extrahepatic portal vein was 110（30 ～ 640）μm. Total wall thickness was 373（160~1320）μm. The ratio of portal vein intima thickness to total portal vein wall thickness was 0.341（0.105 ~ 0.636）. Biliary atresia patients were furhter grouped, total wall hickness ≤ 373 μm was defined as portal vein mild thickening group, total wall thickness ＞ 373 μm was defined as severe portal vein thickening group. The survival time of native liver in severe portal vein thickening group was significantly lowerthan that in mild portal vein thickening group （P ＜ 0.05）. Univariate analysis showed that Kasai operation history and cholangitis history were related factors affecting the degree of extrahepatic portal vein wall thickening in biliary atresia （P ＜ 0.05）. Multivariate analysis showed that the history of cholangitis was an independent risk factor for the degree ofextrahepatic portal vein wall thickening in biliary atresia （odds ratio ＝ 4.000, 95% confidence interval as 1.272 ~ 12.578, P ＜ 0.05）.Conclusion Extrahepatic portal vein wall thickening in children with biliary atresia was mainly characterized by interstitial edema under vascular endothelial cells, proliferation of fibers and fibroblasts, and a small amount of inflammatory cell infiltration. The degree of extrahepatic portal vein wall thickening in biliary atresia may affect the survival time of native liver after Kasai operation. Prevention and treatment of cholangitis could help to reduce the degree of portal vein wall thickening. 

 Objective To investigate the clinical manifestations， diagnosis and treatment strategies ofpulmonary mycobacterium tuberculosis （MTB） infection after liver transplantation. Methods Clinical data of7 patients who underwent liver transplantation in Shenzhen Third People's Hospital from January 2018 to January 2021 and complicated with postoperative pulmonary MTB infection were collected， their clinical manifestations， imaging features， diagnosis and treatment methods， and treatment outcomes were analyzed. Results The time of MTBinfection after liver transplantation was 2.5 ～ 48 months， with a median time of 12 months， the infection sites were all in the lungs. Among the 7 cases，5 cases had no obvious clinical symptoms at the time of diagnosis （71.4%）， and 3 caseshad imaging findings of typical MTB infection on lung CT （42.9%）. Tuberculosis （TB） specific antigen was detected in 5 cases （71.4%）， MTB culture was positive in 3 cases （sputum，14.3% ； alveolar lavage fluid in 2 cases，28.6%）， and MTB nucleic acid test was positive in 2 cases （28.6%）. The anti-TB treatment strategies of the 7 patients included HRZE regimen in 1 case，1 case had isoniazid monotherapy，1 case had levofloxacin + isoniazid + ethambutol regimen， 1 case had moxifloxacin + linezolid +ethambutol + isoniazid regimen，2 cases had moxifloxacin + linezolid regimen， and1 case received rifapentine + isoniazid regimen. At follow-up from 2 to 19 months，2 patients died more than 3 months after liver transplantation，3 patients were cured of pulmonary MTB infection， and 2 patients were still receiving anti-TB treatment. Conclusion The clinical manifestations of pulmonary MTB infection after liver transplantation are often atypical and difficult to diagnose， the delayed treatment may lead to poor prognosis. Clinicians should fully recognize this disease， screen and treat it as soon as possible.

Objective To investigate the experience of the diagnosis and treatment of intestinal perforation after liver transplantation. Methods We retrospectively analyzed the clinical symptoms， laboratory data， imaging data， treatment methods and prognosis of 20 intestinal perforation patients after liver transplantation admitted at Beijing Friendship Hospital from January 2016 to August 2022.Results The incidence of intestinal perforation in liver transplant recipients was 2.8% （18/642） in children and 0.4% （2/487） in adults. Among 18 pediatric recipients， the median time of onset was 13.5（3.0 ～ 404.0） days after liver transplantation. The onset time of the adult recipients was2 to 16 days after liver transplantation. The main clinical manifestations of intestinal perforation were fever， abdominal distension and pain. Some patients developed diarrhea and vomiting. Plain abdominal radiographs in a vertical position were performed in 7 recipients. Subdiaphragmatic and intra-abdominal free air was observed in 4 recipients. Two recipients underwent gastrointestinal angiography， which showed contrast media extravasation. 70% （14/20） of recipients were positive for bacterial culture. 95% （19/20） recipients underwent exploratory laparotomy. Conservative treatment was performedin an adult patient. Two pediatric recipients died of severe infection. Conclusion Intestinal perforation after liver transplantation can lead to the occurrence and aggravation of infection. The use of hormones and immunosuppressants increases the risk of infection. Monitoring the drainage fluid properties and bacterial culture， timely adjusting theanti-infective drug regimen， and performing exploratory laparotomy and intestinal repair are important means to treatintestinal perforation in recipients after transplantation. 

Objective To explore the effect of surgical method selection on prognosis of lung re-transplantation. Methods A retrospective cohort study was conducted on patients（n ＝15）who chose re-transplantation due to chronic lung allograft dysfunction（CLAD）at Wuxi Lung Transplant Center from January 1，2015 to December 31，2021.We analyzed the indications for re-transplantation，intraoperative conditions，perioperative and longterm survival rates，and compared them within groups based on the choice of surgical methods. Results In the 15 CLADpatients，the survival rate of patients who chose right single lung and double lung re-transplantation was better than that of left single lung re-transplantation，while double lung re-transplantation was not better than right single lung transplantation. Conclusion The choice of surgical method for the recipient of secondary lung transplantation affects the prognosis of patients . Further exploration is needed to select reasonable surgical methods according to different indications of patients. 

Objective We retrospectively analyzed the immune characteristics of lymphocytes in patients withBK virus（BKV）activation after renal transplantation，and compared the impact of the areas under the lymphocyte curve （L_AUC）on BKV activation after renal transplantation. Methods Among 154 consecutive patients who underwent their first renal transplantation at our center between 2020 and 2021，a total number of 131 patients who met the inclusion criteriawere retrospectively studied. We divided these patients into BKV negative group and BKV reactivation group based on theBKV-DNA load in urine and blood after renal transplantation. L_AUC was calculated as the area under the lymphocyte curve. We calculated L_AUC from day 0 to day 30. The risk factors for BKV reactivation and relationship with L_AUC in the early period after renal transplantation were analyzed. Results BKV activation was detected in 40 cases at six months after renal transplantation. The lymphocyte count was lower in BKV activation group than BKV negative group，and thereindependent risk factor for BKV activation（95% CI ＝ 1.416 ～ 8.726，P ＝ 0.007），and female was a protective factor （95% CI ＝ 0.129 ～ 0.723，P ＝ 0.007）. Conclusion L_AUC is associated with BKV activation after renal transplantation，patients with low L_AUC30daysaftersurgery are morelikelyto haveBKVactivation. 

Objective To investigate the incidence and influential factors of low level of viremia（LLV） inhepatitis B related liver transplantation（LT） recipients. Methods We retrospectively analyzed the clinical data of 90 recipients who underwent liver transplantation for hepatitis B related end-stage liver disease in the Affiliated Hospital of Qingdao University，49 recipients meeting the inclusion criteria who underwent LT from December 2006 to February 2021 were enrolled. Real-time fluorescent quantitative polymerase chain reaction（RT-qPCR） was used to detect hepatitis B virus （HBV） DNA levels in these recipients. According to HBV DNA load， the recipients were divided into two groups ：LLV group（6 recipients） and complete virological response （CVR） group（43 recipients）. The incidence ofLLV and risk factors of LLV in hepatitis B LT recipients were analyzed. ResultsThere were 6 recipients in LLV group had no recurrence of hepatitis B indicated by routine detection methods， with an incidence of LLV of 12.24%. Among the6 LLV recipients，2 were given nucleoside analogues（NAs）+ hepatitis B immune globulin（HBIG）and 4 were given NAs for prevention of hepatitis B recurrence. Univariate analysis showed that high preoperative HBV DNA load， postoperative tumor recurrence， preoperative tumor stage beyond UCSF criteria and low body mass index （BMI） were the risk factors for LLV in hepatitis B LT recipients （P ＜ 0.05）. Multivariate analysis showed that high preoperative HBV DNA load was an independent risk factors for LLV in hepatitis B LT recipients. Conclusion High preoperative HBV DNAload， postoperative tumor recurrence and preoperative tumor stage beyond UCSF criteria were related to LLV in hepatitis B LT recipients. High preoperative HBV DNA load was an independent risk factors for LLV in hepatitis B LT recipients. Therefore， it is recommended to monitor LLV dynamically by highly sensitive fluorescent quantitative PCR in hepatitis B LT recipients， especially in recipients with late tumor stage and positive HBV DNA before liver transplantation. 

Objective To investigate the colonization of multidrug resistant organisms （MDROs） and the impact of antibiotic therapies on MDROs colonization in patients with cholangitis after Kasai procedure，and to provide scientific evidence for clinical prevention and control measures. Methods Cases with cholangitis after Kasai surgery from January 2021 to June 2022 in Tianjin First Central Hospital were retrospectively collected. The children were divided into case group （colonized） and control group （non-colonized） according to their MDROs colonization status when admitted to pediatric department， and the general conditions， Kasai procedure time， biliary atresia classification， previous cholangitis times and previous use of antibiotics were compared between the two groups. Results A total number of 76 strains of pathogenic bacteria were detected in rectal swabs of 64 children， including 43in the MDROs group and 21 in the non-MDROS group.Klebsiella pneumoniae was the most common bacterium （37 cases，33cases were carbapenemresistant）， followed by Enterococcus faecium（12 cases，1 case was vancomycin resistant） and Escherichia coli（11 cases，4 cases were carbapenem-resistant）. There were no significant differences in general conditions， Kasai operation time， biliary atresia classification， and previous cholangitis times between the two groups. The rate of therapy with carbapenems in MDROs group was higher than that in non-MDROS group （53.5% vs. 33.3%，P ＝ 0.129）. The rate of therapy with broadspectrum antibiotics in MDROs group was higher than that in non-MDROS group （39.5%vs. 19.0%，P ＝ 0.101）. The rate of therapy with more than two antibiotics in MDROs ，group was higher than that in non-MDROS group （51.2% vs. 19.0%，P＝0.014）. ConclusionCombination antimicrobial therapy with two or more drugs may lead to colonization of MDROsresulting in bloodstream infection and biliary tract infection of MDROs due to intestinal bacterial translocation. Therefore，effective prevention and treatment measures should be taken to reduce the incidence of MDROs in children after Kasai. 

Objective To investigate the pathogenic microbiological characteristics， clinical characteristics，diagnosis and treatment experience of interstitial pneumonia after renal transplantation. Methods The 109 patientswith interstitial pneumonia after renal transplantation diagnosed in the First Affiliated Hospital of Xi'an Jiaotong University from January 2018 to June 2022 were selected. The clinical characteristics，results of pathogenic microbiology， antiinfection strategies and clinical outcomes were analyzed retrospectively. ResultsPathogenic diagnosis of interstitialpneumonia after renal transplantation was difficult， and mixed infection was the main pathogenesis. The main pathogenswere pneumocystis jirovecii in 26 cases （23.9%）， cytomegalovirus in 22 cases （20.2%）， mycoplasma in 15 cases （13.8%），and klebsiella pneumoniaein 13cases （11.9%）. After comprehensive treatment，97 patients（89.0%） were cured and 12（11.0%） died. ConclusionThe diagnosis of interstitial pneumonia after renal transplantation is based on clinical symptoms and imaging manifestations. Pneumocystis jirovecii and cytomegalovirus are the main pathogens. Dynamicmonitoring， early diagnosis and early preventive full course treatment should be carried out for high-risk patients. In the clinic， the key to the treatment of interstitial pneumonia is to provide oxygen support in time， adjust the immunosuppression scheme， reduce inflammatory factors， timely check the next generation sequencing （NGS），and transform from empirical totargeted effective anti-infection therapy. At the same time， immune function of the body and effective nutritional support are necessary. 

Objective To analyze the systemic infection of organ donation donors， and to provide more clinical evidence for the control of donor infection. Methods 76 cases of organ donation were completed in theDepartment of Critical Care Medicine of the Third Affiliated Hospital of PLA Military Medical University （Daping Hospital）from January 2017 to December 2021，including 32 cases of donation after brain death （DBD） and 44 cases of donation after circulatory death （DCD）. Clinical data of donor age， sex， cause of disease， infection site， sputum culture and drug sensitivity test results， central venous catheter blood culture and drug sensitivity test results， peripheral blood culture and drug sensitivity test results， urine culture and drug sensitivity test results were collected. Results Lung infection was the most common site in 76 organ donors. Gram negative bacteria accounted for 30.3%， gram positive cocci accounted for 14.4% ，fungi accounted for 5.3%，and 6 strains of multidrug-resistant bacteria accounted for 15.8% of the total cases. Conclusion Infection is not a contraindicated for organ donation. When the donor is found to have infection or suspected infection， anti-infective treatment should be initiated as soon as possible. Samples from various sites should be actively collected for examination to screen the infected sites and determine the pathogenic bacteria，and to guide timely target anti-infective treatment. 

Objective To explore the therapeutic benefit of liver transplantation（LT）on congenital bile acid synthesis disorder（CBAS）. Methods The clinical data of 5 cases with CBAS who underwent liver transplantation at Huashan Hospital affiliated to Fudan University from October 2015 to December 2022，were analyzed retrospectively. Among them，there was 1 patient with CBAS type 1，2 patients with CBAS type 2 and 2 patients with cerebrotendinous xanthomatosis（CTX）. There were 3 males and 2 females. The median age was 9（7 ~ 12）months. There were 4 cases of living donor liver transplantation and 1 case of donation after citizen's death（DCD）liver transplantation. The median follow-up time after surgery was 74（60 ~ 84）months. The preoperative clinical characteristics，intraoperative conditions，postoperative follow-up data of the children were analyzed to evaluate the efficacy of liver transplantation. Results All the surgeries were completed successfully，and one child had rejection，one child had chyllesomerhea，and two children were infected with hepatitis B virus（HBV）. After surgery，one child died due to lung infection，and the remaining 4 children recovered their liver function welland survived normally. Symptoms suchasjaundice and itching subsided，and their growth and development improved. Conclusion Liver transplantation is aneffective treatment for children withCBAS whodo notrespond well to medicaltreatment. 

Objective To summarize cytomegalovirus（CMV）infection in organ donation and kidneytransplantation after the death of citizens，and to analyze of the effectiveness and safety of prevention and preemptive treatment. Methods Among the 243 patients who received the donation after citizen’s death（DD）allogeneic kidney transplantation for the first time in our hospital，90 patients who met the research criteria were selected，according to different CMV viral loads，they were divided into CMV preventive treatment group （group A ：40 cases），CMV infection preemptive treatment group（group B ：34 cases），and negative control group（Group C ：16 cases）with no evidence of CMV infection，the characteristics of CMV infection，the correlation with Tac trough concentration（C0）and the consistence between CMV low matrix phosphorylation protein 65 （pp65） antigenemia and CMV-DNA were observed. The safety and effectiveness of preventivetreatment with low-dose valganciclovir（450 mg/d or 450 mg/2 d）and preemptive treatment with standard dose ganciclovir〔8 ～ 10 mg/（kg·d）〕were also analyzed. Results The total incidence of CMV infection after DD renal transplantation was 82.22% （74/90）， and the incidence of CMV infection within three months after transplantation was 90%（36/40）in group A and 94.11%（32/34）in group B（χ2 ＝ 0.0481， P＞0.05），the time of CMV infection was（65.62 ±45.74）d in patients induced by Baliximab and（33.06 ± 20.11）d in rATG group（t ＝ 2.9922，P ＜ 0.01），there was no correlation between Tac C0 and CMV infection（F ＝ 0.2 879，P ＞ 0.05）. The positive coincidence rate between CMV-PP65 antigenemia and CMV-DNA was 96.4%，and the total coincidence rate was 65.5%；the absolute values of CD8+ T cells（Ts/Tc）and NK cells in CMV-pp65 antigenemiapositive samples were lower than those in pp65 negative samples（P ＜ 0.05）.There was no significant difference in the effectiveness，adverse reactions and acute rejection（AR）between low-dose valganciclovir and standard dose ganciclovir for prevention and preemptive treatment after DD renal transplantation（P ＞ 0.05）. Conclusion Low dose valganciclovir and standard dose ganciclovir are safe and effective in the prevention and preemptive treatment ofDD renal transplantation. With the active monitoring of postoperative CMV infection，the absolute values of CMVpp65，CD8+ T cells（TS / TC）and NK cells can help diagnose CMV infection more timely and accurately. 

 Objective The purpose of this study is to summarize the situation of non-standard donor hearttransplantations（HTx）in Fuwai Hospital，and to compare the HTx outcomes between non-standard donors group and conventional donors group. Methods A retrospective analysis of HTx cases in Fuwai Hospital from January 2015 to December 2021 was conducted to summarize the use of non-standard donors; compare the clinical data of thetwo groups of recipients; analyze the postoperative survival of the two groups of recipients; explore the association between indicators of non-standard donors and postoperative 1-year mortality. Results A total of 616 HTx patients were analyzed，of which 456 were male（70.0%）and 160 were female（30.0%）. The average age was（46.0 ± 14.1）years. In these patients，330 patients were included in non-standard donor group，and 289 were included in conventional standard

donor group. Compared with the standard donor group，the non-standard donor group have longer cardiopulmonary bypass time，higher proportion of postoperative cardiac dysfunction，postoperative ECMO and IABP insertion and postoperative infection. Longer postoperative mechanical ventilation duration and ICU hospitalization duration，and higher serum creatinine before discharge（P ＜ 0.05）were also seen in the non-standard donor group. In terms of prognosis，the in-hospital mortality of the non-standard donor group was higher. Kaplan-Meier survival analysis showed that the one-year survival rate of the non-standard donor group was lower than that of the standard donor group（P ＜ 0.01），but there was no significant difference in the long-term survival rate of the patients who survived for one year after operation between thetwo groups（P ＝ 0.12）. After adjusting for recipient-related factors，multivariate analysis showed that donor coronaryartery abnormalities and donor high-dose positive inotropic drug support were independent risk factors for one-year mortality. Conclusion The application of non-standard donor heart can alleviate the shortage of donor heart resources，but it may increase post-transplant early mortality. Donor high-dose vasoactive drugs support and abnormal coronary artery of donor heart are risk factors of one-year mortality，so we should pay more attention to the management and assessment of donors before donation.

Objective To explore the contrast-enhanced mode and diagnostic value of contrast-enhanced ultrasonography in recurrent lesions of hepatocellular carcinoma after liver transplantation. Methods A totalnumber of 124 liver transplant recipients with pathological confirmed liver cancer recurrence in the OrganTransplantation Department of the Third Medical Center of PLA General Hospital from October 2007 to January 2022were selected as the objects of study.Thecontrast-enhanced mode and contrast-enhanced ultrasound diagnosis ofrecurrent liver cancer were analyzed and compared with pathology. Four tables were used to calculate the sensitivity，specificity，positive predictive value，negative predictive value and accuracy of contrast-enhanced ultrasound inthe diagnosis of liver cancer recurrence after liver transplantation. Linear weighted Kappa test was usedto analyzethe consistency between contrast-enhanced ultrasound and pathological diagnosis.Results Atotal number of124 cases of liver tumor recurrence 

were diagnosed pathologically，including 59 cases of single lesion and 65 cases of multiple foci. Contrast-enhanced ultrasound mode: arterial phase high enhancement in 96 cases，equal enhancement in 16 cases，low enhancement in 12 cases，fast in and fast out in 106 cases，fast in and slow out in 5 cases，equal in and slowout in 11 cases，equal in and slow out in 2 cases. The sensitivity，specificity，positive predictive value，negative predictivevalue and accuracy of contrast-enhanced ultrasound in the diagnosis of recurrence were 97.6%，97.4%，98.4%，96.2% and 97.5%，respectively. The results of contrast-enhanced ultrasound and pathological diagnosis were consistent，and theKappa value was 0.948（P ＜ 0.001）. Conclusion The results of contrast-enhanced ultrasonography are consistentwith pathological diagnosis. According to its characteristic enhancement mode，

contrast-enhanced ultrasound has important clinical value in the diagnosis ofrecurrent liver tumor afterliver transplantation. 

Objective To investigate the effect of polymorphisms of CYP3A5 gene mutation on the metabolism of tacrolimus in renal transplantation recipients after surgery，and to compare the differences in followup parameters of patients with different metabolic function genotypes after kidney transplantation. Methods The recipients who received allograft kidney transplantation from January 2016 to December 2018 were selectedconsecutively，and the data of each follow-up in the perioperative period of kidney transplantation and the electronicmedical record system after the operation were sorted out，mainly including the general information before the operation，the dose of tacrolimus taken at each follow-up time point（the second week，one month，three months，six months，one year and two years after the operation），the concentration-dose ratio，liver and kidney functionpostoperative complications. CYP3A5 genotype was determined by PCR-SSP method before surgery，and kidney transplant recipients were divided into CYP3A5*1 expression group（AA，AG，28 cases in total）and CYP3A5*1 non-expression group（GG，124 cases in total）according to different genotypes. The differences of clinical indicators between the two groups during the follow-up period were compared and systematically analyzed. Results In this study，a total of 152 recipients of kidney transplantation were included according to the above criteria，including 30 recipients of living donor transplants from relatives and 122 recipients of DCD transplants. There were 52 females（34.21%）with an average age of（43.90±10.81）years and an average weight of（65.51±12.02）kg. Patients were divided into groups according to the difference of CYP3A5 expression，and the preoperative basic data of CYP3A5*1 expression group（AA，AG）and non-expression group（GG）were analyzed. The results showed that there was no statistical difference in the basic demographic clinical characteristics between the two groups. The C0/D value of tacrolimus in the CYP3A5*1 expression group was significantly lower than that in the CYP3A5*1 non-expression group at week 2，month 1，3，6，year 1 and year 2 after renal transplantation（P ＜ 0.01）. Thedaily tacrolimus dose of the CYP3A5*1 expression group was also significantly lower than that of the CYP3A5*1non-expression group at each of the above follow-up time points（P ＜ 0.01）. At the 1st month and 2nd year of follow-up after kidney transplantation，the serum trough concentration of tacrolimus in CYP3A5*1 expression group was significantly lower than that in CYP3A5*1 non-expression group（P ＜ 0.01）. There was no significant difference in blood tacrolimus concentration between the two groups at the follow-up time points of 2 weeks，3 months，6 months and 1 year（P ＞ 0.05）. There were no significant differences in serum creatinine，transaminase，hemoglobin， blood glucose levels，renal biopsy pathological types and postoperative complications between the two groups at each follow-up time point（P ＞ 0.05）. Conclusion Compared with CYP3A5*1 non-expression group，patients in CYP3A5*1 expression group metabolized tacrolimus faster after taking tacrolimus，and higher tacrolimus dose is usually required to reach the target blood concentration range after transplantation. The differences of CYP3A5 gene polymorphism among different renal transplant recipients have no significant negative effects on postoperative liver and kidney function，blood glucose level，graft rejection，graft survival and adverse events. 

Objective To study the safety and efficacy of retroperitoneal laparoscopic living donor nephrectomy after freeing subcostal nerve. Methods The clinical data of 126 donors who underwent retroperitoneoscopic living donor nephrectomy in the department of urology，the First Affiliated Hospital of Anhui Medical University from January 2016 to January 2019 were retrospectively analyzed. The donors were divided into two groups depending on whether the subcostal nerve was freed during donor kidneyharvesting，there were 74 donors in the traditional surgery group and 52 donors in the modified surgery group with freeing subcostal nerve. The donor’length of incision，surgery time，intraoperative blood loss，the length of hospitalization，kidney warm ischemia time and visual analogue scale（VAS）at 12 h，24 h and 48 h after surgery were compared between the two groups. Results All patients（n ＝ 126）finished thenephrectomy successfully，and none was transferred to open surgery. The differences in the length of incision，surgery time，kidney warm ischemia time and intraoperative blood loss between the two groups had no statistical significance（P ＞ 0.05）. The postoperative hospital stay was（6.6 ± 1.7）d in the traditional surgery group and（4.8 ± 1.7）d in the modified surgery group，and the difference between the two groups had statistical significance（P ＜ 0.001）. The VAS scores at 12 h，24 h and 48 h after operation in the modified operation group were significantly lower than those in the traditional surgery group，and the differences were statistically significant （P ＜ 0.001）. Conclusion Compared with traditional retroperitoneoscopic surgery，retroperitoneal laparoscopic donor nephrectomy with freeing subcostal nerves is safe and feasible，it can completely preserve the subcostal nerves and shorten the length of hospital stay and short-term postoperative pain.

Objective To summarize the clinical characteristics，diagnosis，treatment and prognosis ofdigestive system malignancy following renal transplantation. Methods The clinical data on fifty-six cases of digestive system malignancy followingrenal transplantationbetween Jan 2000 and July2022 was retrospectively analyzed．Results Among the fifty-sixcases，forty-fourweremalesandtwelve were females.Twoof them had esophageal cancer，ten had gastric carcinoma，twenty-six had liver cancer，three had pancreatic carcinoma，two had tumor of duodenalampulla，and thirteen had intestinal cancer. The diagnosis was made based on the clinical symptoms，laboratory andimaging findings of the patients during follow-up. The patients receivedcomprehensive treatment mainly with surgery. The survival time of patients ranged from one month to eleven years. Conclusion There wasacloserelationshipbetween digestive system tumor and virus infection in renal transplantrecipients. Regular tumor screening after transplantationwas helpful for early diagnosis. According to the characteristics of the tumor，early and appropriate treatment measures should betaken.