Objective To analyze the clinical and pathological characteristics ofpost-transplantlymphoproliferative disorder （PTLD） in children after liver transplantation， and to provide reference for diagnosis and treatment. Methods The clinical and pathological data of PTLD patients after liver transplantation were collected from May 2020 to May 2022 in the Pediatric Liver Transplantation Department of Tianjin First Central Hospital. The gender， age， surgical method， postoperative immunosuppression regimen， PTLD treatment regimen， prognosis， clinical manifestations，liver function， plasma EBV-DNA， and imaging examination results were included. Pathological classification and immunohistochemical staining results were analyzed according to WHO classification of lymphoid tissue tumors in 2016. The clinical， pathological and prognostic features of the patients were analyzed retrospectively. Results There were 8 patients with pathologically diagnosed PTLD after liver transplantation， including 4 males and 4 females， aged 1 ～ 4 years. All the 8 patients had biliary atresia as the primary disease and underwent living donor liver transplantation （LDLT）. In this group，5 cases had lymph node enlargement，5 cases had digestive system symptoms （including abdominal pain，intestinal obstruction， ascites， and abdominal distension），4 cases had liver dysfunction，3 cases had fever， and 1 case had abnormal liver and kidney function. The mean plasma EBV-DNA was 46072copies/ml. The non-destructive， pleomorphic and monomorphic cases accounted for 12.5% （1/8），25% （2/8） and 62.5% （5/8）， respectively. Burkitt lymphoma， diffuselarge B-cell lymphoma and mature T-cell lymphoma accounted for 60% （3/5），20% （1/5） and 20% （1/8） of monomorphic PTLD， respectively. After diagnosis， tacrolimus was tapered or discontinued. Six patients received chemotherapy and2 patients received hemodialysis. Two cases of local space occupying operation was performed. Of the 8 patients，7 caseshad remission and 1 died. Conclusion The early diagnosis of PTLD and the selection of reasonable treatment planaccording to pathological classification can improve the prognosis of patients. Children receiving chemotherapy should be alert to tumolysis syndrome and be given active and effective intervention in time. 

Objective To optimize triple immunosuppressive dose in renal transplantation. Methods According to the dose of triple combined immunosuppressive regimen，200 patients were divided into conventional dose group（n＝145）and low-dose group（n＝128）. The dose of immunosuppressive regimen at two，four weeks， two，three and six months post-transplantation，the incidences of acute rejection，pulmonary infection and patient/graft survival rate were compared respectively between the two groups. Results The dose of triple immunosuppressive agents in the low-dose group was significantly lower than that in conventional dose group at six months post-transplantation. During the first six months post-transplantation，acute rejection including biopsy-proven and clinical presumed acute rejection occurred in 24 of 145 patients（16.5%）in the conventional dose group，and in 24 of 128 patients（18.7%）in the low-dose group（P＞0.05）. At six months post-transplantation，pulmonary infection， especially severe pulmonary infection，had a significantly higher occurrence in the conventional dose than in the low-dose group（30.4% vs 10.2% and 22.1% vs 4.7% respectively，both P＜0.01）. At 12 months，patient survival rate was 89.7% and 98.4%（P＜0.01），while the graft survival rate was 86.9% and 96.9%（P＜0.01）in the conventional dose group and low-dose group respectively. Excluding the death caused by infection with normal renal function，no significant difference was noted between the two groups（P＞0.05）. Conclusion The low-dose combination of triple immunosuppressive agents post-transplantation can significantly reduce the pulmonary infection and mortality without increasing the incidence and severity of acute rejection and subclinical rejection.

Objective To evaluate efficacy and safety of long-acting or intermediate-acting insulin combined with oral hypoglycemic drug in treatment of patients with high blood sugar early after kidney transplantation. Methods 45 cases at 1 month after kidney transplantation with high blood glucose were divided into three groups according to insulin used，insulin detemir group（A），insulin glargine group（B）and Novolin N group（C），and 15 patients in each group. The original oral acarbose dose was maintained，and each group of patients received 1 dose a day injections of insulin for 4 weeks. Blood glucose and incidence of hypoglycemia were monitored. Results Fasting blood glucose and post prandial blood sugar after treatment of three groups were significantly decreased，with most

significantly decreased in the A group ；and A，B groups decreased more than C group〔fasting blood glucose （mmol/L）：3.08±0.51，2.86±0.58 vs. 0.92±0.34 ；post prandial blood sugar（mmol/L）：4.38±1.19，4.18±1.22 vs. 2.34±0.77〕，the difference was statistically significant（all P＜0.05）；A，B groups of hypoglycemia events were obviously less than group C（6%，13% vs. 26%）. Conclusions In patients early after kidney transplantation with high blood glucose and cannot be controlled well by acarbose，treatment with addition of long-acting or intermediate- acting insulin can decrease the level of blood glucose obviously. Insulin detemir is effective and gentle for control forblood glucose with less incidence of hypoglycemia，which is a more ideal physiological simulated insulin secretion.

Objective To analyze clinical characteristics of posttransplant lymphoproliferativedisorder （PTLD） after pediatric liver transplantation, and to summarize its clinical diagnosis and treatment experience. Methods We retrospectively analyzed the clinical characteristics, laboratory data, radiological data, pathological result, treatment, and prognosis of 18 pediatric PTLD patients after liver transplantation presenting toBeijing Friendship Hospital from January, 2017 to September, 2019. Results A total of 18 patients were included in this study. The median age at surgery was 15.9 months （range, 4.6 ~ 146.7）, and the median onset time of PTLD was 15.1 months （range, 4.2 ~ 30.1） postoperatively. 88.9% （16/18） of patients had superficial lymphadenopathy, 94.4% （17/18） had Epstein-Barr viremia, and 88.9% （16/18） was EBER positive. In 17 patients, positron emission computed tomography （PET）-CT revealed increased FDG metabolism in the associated enlarged lymph nodes. All 18 patients underwent immunosuppression reduction, and were treated with targeted therapy, chemotherapy, surgery and adoptiveimmunotherapy with EBV-CTLs （EBV-specific cytotoxic T-cells） according to the pathological type. One patient died and 17 had clinical remission. ConclusionThe increased incidence of PTLD after pediatric liver transplantation may be related to EBV infection and high level of immunosuppression. The possibility of PTLD should be consideredin patients with EB-Viremia and superficial lymphadenopathy but without nonspecific symptoms. Monitoring EBVDNA replication load and reducing the level of immunosuppression are important means to treat PTLD in children after liver transplantation. Early diagnosis and treatment are of great significance to the prognosis of PTLD. 

Objective We used the principle of extracorporeal membrane oxygenation（ECMO）to assembleour own normothermic machine perfusion（NMP）system，and to verify the effect and stability of NMP in the split liver process of perfusion and preservation of Bama miniature pig. Methods Four healthy Bama miniature pig were selected，the liver was quickly harvested and was connected to the NMP device for preservation and perfusion. In the process of split，portal vein，hepatic artery flow and pressure，the temperature of liver preservation were recorded. Results During the liver splitting procedure, the portal vein pressure was maintained between 8.75- 9.75 mmHg（1 mmHg ＝ 0.133 kPa）. Meanwhile, the hepatic artery pressure was maintained in a range of 92.00- 92.75 mmHg. In the splitting process, portal venous flow reduced from（455.00±107.55）mmHg before splitting to （392.50±125.27）mmHg after splitting, while hepatic artery flow reduced from（180.75±59.46）mmHg before splitting to（126.25±6.99）mmHg after splitting. Before splitting, the pH value（7.24±0.10）was lower than the baseline value（7.50±0.08）, and it gradually increased with splitting and reached a value of（7.60±0.13）after splitting, which was slightly higher than the baseline value. The PO2 was maintained in a range of 482.25-521.00 mmHg during splitting, which was significantly higher than the baseline value（304.00±78.11）mmHg. HCO3 - was（10.10± 5.04）mmol/L before splitting，which was significantly lower than the baseline value of（24.05±0.31）mmol/L， while it gradually increased. Na + was maintained in a range of 142.75-149.25mmol/L during splitting. During the preservation splitting，K+ gradually increased from（3.45±0.33）mmol/L at baseline to（4.98±1.12）mmol/L at the end of splitting. Before splitting, the lactic acid was（2.86±1.77）mmol/L, which was lower than the baseline value of （3.85±2.58）mmol/L，and it gradually increased to（6.00±3.73）mmol/L at the end of splitting. The bile secretion was gradually reduced with splitting before splitting ：（16.75±3.30）ml/h, during splitting ：（10.55±1.83）ml/h，and after splitting ：（6.53±1.33）ml/h. At the beginning of perfusion preservation，the alanine aminotransferase（ALT）， lactate dehydrogenase（LDH），and alkaline phosphatase（ALP）were lower than the baseline level. ALT and LDH gradually increased with splitting，whereas ALP was maintained in a lower level in the splitting. At the beginning of perfusion preservation, aspartate aminotransferase（AST）was comparable with the baseline value，and it was gradually increased with splitting. The cell structure in the liver did not show significant changes after splitting with NMP preservation compared with that before the preservation. Conclusion Our NMP system in the process of liver splitting is relatively stable，with a certain clinical value.

Objective Post-renal transplantation anemia（PTA）occurs frequently in kidney transplant recipients，significantly impacting their quality of life and graft loss. Currently，effective methods to predictthe risk of persistent PTA early post-transplantation are lacking. This study aimed to develop a nomogram prediction model for early persistent PTA specifically tailored to kidney transplant recipients. Methods Using the electronic medical record system of Southern Hospital of Southern Medical University，patient data from January 1，2020 to December 31，2022 were obtained，and 245 subjects were ultimately selected as the research subjects. Among these，85% were randomly selected as the training set for model development，and the remaining 15% constituted the testing set. Using the Least Absolute Shrinkage and Selection Operator（Lasso）regression model，variables potentially affecting early persistent PTA were screened to identify predictive factors.A logistic regression analysis was employed to establish the prediction model. Model performance was assessed using Receiver operating characteristic（ROC）curves，area under the curve（AUC），Calibration plots，and decision Curve Analysis（DCA）. Results Identified predictive factors after screening included recipient's preoperative body mass index，preoperative serum albumin level，preoperative hemoglobin level，preoperative mean corpuscular volume，perioperative use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers，exogenous iron supplementation，and exogenous erythropoietin supplementation. The model demonstrated good discriminativeability with an AUC of 0.87 for the training set and 0.75 for the testing set，indicating robust predictive performance. Calibration and DCA further confirmed the accuracy and clinical utility of the model. Conclusion This nomogram prediction model utilizes early recipient information，including demographic characteristics，laboratory data，and medication regimens，to accurately predict individualized risk of early persistent PTA in kidney transplant recipients. This provides a basis for early clinical intervention，potentially improving patient prognosis and quality of life.