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

Objective To investigate the main causes of kidney transplantation graft loss，and analyze independent risk factors for loss of graft by chronic rejection. Methods The prognosis of all kidney transplantrecipients from January 2015 to January 2023 was retrospectively analyzed. A total number of 14 recipients with renal graft loss due to chronic rejection were selected as the case group，and 56 recipients corresponding to 28 donors without donor kidney loss were selected as the control group. Clinical data of the two groups of recipients and corresponding donors were retrospectively analyzed，and logistic regression analysis was carried out. Results Inthe past 8 years，147 cases experienced renal graft loss，including 67 cases of renal graft dysfunction and 80 cases of death. The top three causes of renal graft dysfunction were chronic rejection，vascular embolism and relapse of nephropathy. The top three causes of death in transplant patients were infection，cardiovascular accidents and digestive complications. Multivariate logistic regression analysis showed that there was a statistically significant difference in donor age between the case group and the control group（P ＝ 0.012）. Conclusion In our center， chronic rejection was the main cause of renal graft failure. The leading causes of death in kidney transplant patients are infection and cardiovascular problems. Age of the donors is the independent risk factor for renal graft loss bychronic rejection. 

 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. 

肾移植 ； 肺部感染 ； 宏基因二代测序 ； 治疗经验

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

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

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

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

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. 

ObjectiveThis survey was conducted to get some knowledge about the growth status and intestinal microecology of pediatric liver transplantation patients. MethodsA total of 30 children’s stool sample were collected, the samples were analyzed by gene sequencing. Meanwhile, the clinical data and personal information were included into analysis. ResultsThe average month age was （6.1±1.5）m. The average height, weight and body mass index （BMI） were （65.8±3.7）cm, （6.7±1.1）kg and 15.1±1.6, respectively. As for the gender, 10 cases were men while 20 cases were women. The most common blood type was A which accounted for 33.3%, followed by B（23.3%）, O（30.0%） and AB（13.4%）. There were statistical differences between normal and abnormal groups in weight, BMI, weight Z score and BMI Z score on the operation day. However, 18 months after operation, there were statistical differences betweentwo groups in height and weight. ConclusionLiver transplantation can improve the growth of biliary atresia patients, and intestinal flora correlates to growth. 

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. 

ObjectiveA retrospective analysis of clinical data was performed to uncover riskfactors for obstructive sleep apnea （OSA） in patients after lung transplantation. MethodsFrom January 1， 2020 to January 1，2022，the clinical data of 27 patients with OSA as well as 28 patients without OSA after lung transplantation in Wuxi People's Hospital were collected. Polysomnography （PSG） was performed in clinically stable patients ＞ 1 month after transplantation，according to the apnea-hypopnea index （AHI）＝ 5 events/h，ithe patients were divided into OSA group （AHI ≥ 5 events/h） and non-OSA group （AHI ＜ 5 events/h）. The differences in observation indicators between the two groups were analyzed， and univariate and multivariate logisit regression analysis was performed. ResultsThe body mass index（BMI）、neck circumference and ratio of pre-transplant COPD/IPFto other lung diseases of the OSA group were significantly higher than those in the non-OSA group. Univariate logisticregression analysis showed BMI （OR ＝ 1.263，95% CI ＝ 1.051 ～ 1.517，P ＝ 0.013）， neck circumference （OR ＝1.180，95% CI ＝ 1.014 ～ 1.374，P ＝ 0.032）， and the ratio of pre-transplant COPD/IPF to other lung diseases （OR ＝8.088，95% CI ＝ 1.588 ～ 41.189，P ＝ 0.012） as risk factors. Multivariate logistic regression analysis showed that theratio of pre-transplant COPD/IPF to other lung diseases （OR ＝ 5.784，95% CI ＝ 1.047 ～ 31.963，P ＝ 0.044） was anindependent risk factor. ConclusionBMI， neck circumference， and pre-transplant COPD were risk factors for OSA in post-transplant patients， and pre-transplant COPD was an independent risk factor for OSA. 

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.