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 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 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 In order to explore the influence of liver regeneration on tumor recurrence after partial hepatectomy as well as the possible mechanisms. Methods Portal vein injection of 256 tumor cells suspension after partial hepatectomy was performed to simulate the tumor recurrence and metastasis . The animals were divided into three groups（H0 group， H30 group and H70 group）according to different proportion of hepatectomy. The rate of tumor recurrence， change in body weight， tumor-bearing graft weight， tumor-bearing graft to body weight ratio were comparedamong three groups after three weeks. Meanwhile， the accumulate abundance of protein CAPNS-1 and the PCNA index were utilized to judge the tumor invasiveness. Western Blot and RT-PCR analyses were applied respectively to assess the abundance of protein c-met， VEGFR-2 and mRNA. Moreover， the relation between the tumor invasiveness and the abundance of c-met，VEGFR-2 were explored. Results All rats in H70， H30 and H0 groups were alive after 3 weeks with metastatic tumor lesions in their livers. The extent of increase or decrease in general indexes， such as body weight，tumor-bearing graft weight and tumor-bearing graft to body weight ratio， were obviously in group H70. And the tumors in rats of group H70 revealed upper invasiveness and malignant potential. In addition， the H70 group displayed diffuse distribution of tumors. The level of CAPNS-1 expression and the PCNA index were evaluated in H70. The largest resection was also associated with significant up-regulation of c-met， VEGFR-2 protein and mRNA expression. Furthermore， there was a significantly correlation between the level of VEGFR-2， c-met and the change in general indexes， and the level of CAPNS-1 protein expression. Conclusion This research reveals that liver regeneration after partial hepatectomy not only can accelerate the malignant transformation， but also can promote tumor growth. 

Objective To investigate the associated risk factors affecting the development ofposttransplantation diabetes mellitus （PTDM） and to analyze the effect of PTDM on patient outcomes. Methods We selected patients who underwent liver transplantation from DCD donors at the hepatobiliary center of the First Affiliated Hospital of Nanjing Medical University between January 2015 and September 2020. The patients were divided into PTDM and non PTDM groups， and the baseline characteristics， intraoperative information and postoperative complications werecompared between the two groups. A competing risk model was used to identify relevant risk factors affecting the occurrence of PTDM， and Cox regression was used to analyze the effect of PTDM on patient outcomes. Results The incidence of diabetes at 1，3 and 5 years after liver transplantation was 13.3%，16.9%，27.0%， respectively. There were statistically significant differences in patient age， length of postoperative hospital stay， and immune rejection between groups. Afteraccounting for death as a competing risk event，every 10-year increase in age was associated with a 45% increased risk of developing PTDM （SHR ＝ 1.45，95% CI ＝ 1.17 ～ 1.80）； The risk of PTDM in patients with immune rejection was 2.06 times higher than that in patients without immune rejection （95% CI ＝ 1.00 ～ 4.24）； Patients hospitalized for more than one month postoperatively had a 62% increased risk of developing PTDM （SHR ＝ 1.62，95% CI ＝ 1.01 ～ 2.59）. The risk of late infectious complications in PTDM patients was 2.48 times higher than non PTDM patients （95% CI ＝1.22 ～ 5.04）； Whereas the incidence of late biliary complications was not statistically different between the two groups （RR＝ 1.58，95% CI＝ 0.77～ 3.26）. After controlling for disease diagnosis， patients in the PTDM group had a 1.73-fold （95% CI ＝ 1.07 ～ 2.77） higher risk of death than non PTDM patients. Conclusion The incidence of PTDM is associated with patient age， immune rejection， and long postoperative hospitalization， and the overall survival of PTDM patients is poor， with a rising risk of late postoperative infection. After transplantation， blood glucose should be screened early to prevent PTDM， in the hope of reducing the occurrence of PTDM and improving patient outcomes.

 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 compare the BK virus infection in urine and blood of kidney transplantation recipients under the therapy of monoclonal antibody immune induction or polyclonal antibody immune induction during the same period. Methods The urine and blood BK virus DNA test results of a total of 298 patients who underwent kidney transplantation in our hospital from January 2017 to July 2019 were retrospectively collected. According to the different immune induction treatment regimens， the recipients were divided into two groups ： monoclonal antibody group with 85 cases， and polyclonal antibody group with 214 cases. The BK virus infectionresults in both groups were compared， the impact of the different immunization induction therapy on the BK virus infection in kidney transplant recipients was explored. Results The results of all the patients show that thepositive rate of urine BK virus was 50.00% （149/298）， the positive rate of blood BK virus was 3.69% （11/298）. Afterthe kidney transplantation， the positive rate of urine BK virus was significantly higher than that of blood BK virus（P ＜ 0.01）. The positive rate of urine BK virus in the monoclonal antibody group was 50.59% （43/85）， and the positive rate of urine BK virus in the polyclonal antibody group was 49.77% （106/213）， the difference was not statistically significant （χ2 ＝ 0.165，P ＞ 0.05）. The positive rate of BK virus in the blood of the monoclonal antibody group was 2.35% （2/85）， and the positive rate of BK virus in the blood of the polyclonal antibody group was 4.22% （9/213）， the difference was not statistically significant （χ2 ＝ 0.188，P ＞ 0.05）. Conclusion For the BK virus infection after the kidney transplantation， there is no significant difference between monoclonal antibody immune induction therapy group and polyclonal antibody immune induction therapy group. While the infection rate of BK virus in both groups is very high. After the kidney transplantation， strengthening the monitoring of BK virus and adjusting the immunosuppressive regimen in time are very important. 

 Objective To investigate the influence of donor diabetes on the overall prognosis of patients with acute-chronic liver failure （ACLF） after liver transplantation. Methods A retrospective study was conducted in 839 ACLF patients who received liver transplantation from January 1，2013 to December 31，2013 in Scientific Registry of Transplant Recipients （SRTR） database. Then， the recipients were divided into two groups according to whether they used diabetic donors （93 cases were in DM group，746 cases were in non-DM group）. Donor and recipient baseline characteristics were compared between two groups， and overall survival rates were compared according to different recipient ACLF grades. Univariate and multivariable analysis were further used. Results The overall survival rates were comparable in patients with ACLF1 and ACLF2. However， in patients with ACLF3， the 1，3，5-year overall survival rates were 84.3%，78.3%，72.4% in the non-DM group，it was significantly better than that in the DM group， which were 70.4%，55.6%，51.9%， respectively （P ＝ 0.016）. It showed statistically significant differences in ACLF3. In multivariateanalysis， the age of the recipient （P ＝ 0.001）and the diabetes of the donor （P ＝ 0.007） were independent predictors for post-transplant overall survival for patients with ACLF3. Conclusion In patients with ACLF3， donor diabetes is anindependent predictor for inferior overall survival after liver 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 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 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 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 evaluate the effect and safty of islet transplantation after kidney transplantation for patients with type 2 diabetes mellitus（T2DM）and end-stage renal disease. Methods One case of islet transplantation was performed on a patient with T2DM complicated with chronic renal failure who had received kidney transplantation 3 months ago. The recipient was given exgenous insulin therapy with a dose of 1.26 U/（kg·d） before islet transplantation. The islets were transplanted into the liver through interna jugular vein transhepatic portal catheterization， as TIPS approach， the portal channel was established within the main portal vein， and the islets were slowly injected into the recipient's liver at a constant speed. Anti-CD25 monoclonal antibody was used as induction and a combination ofetanercept， mycophenolate mofetil and tacrolimus were used as maintenance immunosuppression therapy. Insulin dose， the level of blood glucose， C-peptide and the value of HbA1c were observed.Results Blood glucose was normal soon afteroperation， and the exogenous insulin was suspended. The fasting blood glucose was 4.8 ~ 8.5 mmol/L and the postprandial blood glucose was 6.9 ~ 15.1 mmol/L within the first week after operation. The total amount of exogenous insulin decreased by 50.14% compared with that before operation. The value of HbA1c was 6.3% within the first week after operation（the level of HbA1c was 6.6% before operation）. The fasting and postprandial C-peptide and insulin levels increased after operation. On the 7th day after operation， insulin and C-peptide release tests were performed. The results showed that the function of transplanted islets was partially restored, and insulin secretion was rhythmic. Conclusion Islet transplantation is an effective treatment for T2DM patients with ESRD after kidney transplantation.

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.