Objective Based on the concept of organ medicine and the application of normothermic machine perfusion technology，a new in vitro and in vivo multi-organ laparoscopic system was created. Methods Smagister consists of a normothermic machine perfusion platform，porcine abdominal organs（liver，gallbladder，pancreas， stomach，intestine，kidney，uterus，bladder，etc.），a laparoscopic light source，a laparoscopic lens，an ultrasonic scalpel，laparoscopic surgical instruments，a high-definition monitor，and a software system. The logbook recordedthe results of blood gas analysis per hour and the number of intestinal peristalsis per hour. Organ population viability was subjectively assessed hourly by means of questionnaires. Three types of Laparoscopic surgery are performed on the Smagister，including laparoscopic cholecystectomy（LC），laparoscopic enterotomy closure（LEC）， laparoscopic liver resection（LLR），to demonstrate the specific procedures of each procedure. Experts in related fields were invited to compare the feasibility of completing the operation and the demonstration of complications with the actual operation. Results The mean arterial pressure of the perfusion machine was maintained at60 mmHg（1 mmHg ＝ 0.133 kPa），blood flow at approximately 1 000 ml/min，and organ temperature between 36.5 ～ 37.4℃ throughout the procedure. The intestinal peristalsis could be clearly seen during the whole perfusion process，with an average peristalsis frequency of 2.2 times /min，which was maintained until the end of the experiment. During the laparoscopic operation，clear bile secretion could be seen when the porta hepatis were separated and the bile duct was ligated. In addition，when the blood vessel was injured during liver resection，the blood vessel rupture and blood outflow can be seen. Experts evaluated that the organ activity was good during the whole laparoscopic operation，the anatomical structure of the organ could be clearly displayed，and the tactile feedback of the operation was very real. Conclusion Smagister combines a live animal model with an ex vivo simulation，pooling the advantages of both modalities and expanding the training field to provide high-quality laparoscopic training for both novice and veteran surgeons. 

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 effect of wuzhi capsule combined with CYP3A5*3 genetic polymorphism on the tacrolimus blood trough concentration （C0） of renal transplant recipients in the early post transplant stage. Methods CYP3A5*3 genotypes were determined by polymerase chain reaction-restriction fragment length polymorphism （PCR-RFLP）. Tacrolimus C0 was tested using chemiluminescence immunoassay （CMIA）. The effect of both the daily dose （D） of wuzhi capsule and CYP3A5*3 genotype on the tacrolimusdose-adjusted trough concentration （C0/D） was evaluated in the early post transplant stage. Results Among all of the different wuzhi capsule groups （0，22.5 and 45 mg）， tacrolimus C0/D of CYP3A5 expressers （*1/*1+*1/*3） wassignificantly lower than that of non-expressers （*3/*3） on day 3，7 and 14 after renal transplantation （P ＜ 0.05）. InCYP3A5 expressers on day 3，7 and 14， there were significant differences of tacrolimus C0/D among different wuzhi capluse groups （0，22.5 and 45 mg）. However， on day 14， tacrolimus C0/D with 67.5 mg wuzhi capsule group was significantly lower than those of both 22.5 mg and 45 mg groups （P ＞ 0.05）， and tacrolimus C0/D with 45 mg groupwas significantly lower than that of 22.5 mg group （P ＞ 0.05）. Conclusion For renal transplant recipients with CYP3A5 express， wuzhi capsule could be used to increase the blood concentration of tacrolimus and reduce its costs in the early stage after transplantation. 

Objective To investigate the status quo of readiness for return-to-work among patients afterkidney transplantation and to analyze its influencing factors. Methods By using the general data questionnaire，Chinese version of the readiness for return-to-work scale（RRTW），brief illness perception questionnaire（BIPQ）and the general self-efficacy scale（GSES），a total of 241 respondents from transplantation clinics of two teaching affiliated hospitals in Wuhan were investigated. Results The rate of return-to-work among kidney transplant recipients was 50.2%，and the mean return time was（8.57±7.09）months after surgery. Patients who did not return-to-work accounted for the highest proportion in intention stage（43.3%）. Meanwhile，the proportion of patients who had returned to work in active maintenance stage was 71.7%. The average score was（38.21±8.95）points for illness perception，（23.53±4.44）points for self-efficacy. Renal function，whether having children，illness perception and self-efficacy were the influencing factors of readiness for return-to-work among kidney transplant recipients（all P ＜ 0.05）. Conclusion Kidney transplant patients' readiness for return-to-work is at a moderate level. Medical workers should pay attention to postoperative health follow-up of patients and provide targeted interventions to helpthem return to work and improve their readiness for return to work.

Objective To investigate the current status of kinesiophobia in liver transplant recipients and to explore its influencing factors. Methods Liver transplant recipients who were hospitalized or followed up at theOrgan Transplantation Center of Jiangsu Province Hospital from January to September 2025 were selected by conveniencesampling. The 13-item Tampa Scale for Kinesiophobia （TSK-13）， Patient Health Questionnaire-9（PHQ-9）， FatigueSeverity Scale （FSS）， Sarcopenia-Five （SARC-F） questionnaire， and Health Literacy Scale for Chronic Patients were used for assessment. Univariate analysis， Pearson correlation analysis， and multiple linear regression analysis were performed to identify factors associated with kinesiophobia. Results The mean score of kinesiophobia among liver transplant recipients was （31.61±6.13）， and 37.6% of them had moderate-to-severe kinesiophobia. Univariate analysis showed that gender and living alone were significantly associated with kinesiophobia levels （P ＜ 0.05）. Pearson correlation analysis revealed that kinesiophobia scores were positively correlated with fatigue， sarcopenia， and depression scores （all P＜0.05）. Multiple linear regression analysis indicated that living alone， fatigue， and depression were independent influencing factorsof kinesiophobia （all P ＜ 0.05）. Conclusion Kinesiophobia is prevalent in postoperative liver transplant recipients，with nearly 40% experiencing moderate-to-severe levels. Living alone， fatigue， and depression are the main independent risk factors. Clinical medical staff should routinely screen for kinesiophobia and related risk factors， and implement comprehensive interventions for high-risk patients to effectively reduce kinesiophobia and improve long-term quality of life. 

Objective To summarize the genotype and phenotype characteristics of children with coenzyme Q8B（COQ8B）-associated nephropathy and the prognosis related to kidney transplantation，in order to provide reference for the diagnosis and treatment of patients with COQ8B-associatednephropathy. Methods The genotypes，phenotypes and prognosis of children with COQ8B-relatednephropathy who underwent kidney transplantation in the First Affiliated Hospital of Sun Yat-sen University from 2017 to 2022 were retrospectively analyzed. The inclusion criteria of the patients were carriers of pathogenic mutation of COQ8B detected by next-generation sequencing（NGS）. Results A total number of18 children with COQ8B-associated nephropathy were included in the study，including 13 children with compound heterozygous mutation of COQ8B and 5 with homozygous mutation of COQ8B，c.748G ＞ C was the most commonmutation in this cohort. The average age of disease onset was（9.09±2.57）years，and the average age of reaching end-stage renal disease was（9.72±2.84）years. Among the 18 cases，15 cases showed isolated nephropathy and3 cases had extrarenal organ involvement. The average follow-up time was 31.7 months，during the follow-up period，only one patient had rejection，and there was no recurrence of primary nephropathy and renal allograft failure. Thegrowth of the children was improved after operation. The median height-for-age z-score（HAZ）before operation was -1.47（-1.95，-0.9），the median HAZ one year after operation was -1.25（-1.77，-0.7），and the median HAZ of the second year after operation was -0.91（-1.24，-0.34）. Conclusion COQ8B-associated nephropathy is characterized by isolated nephrotic syndrome and less involvement of extrarenal organs. Kidney transplantation is a safe and effective treatment for children who are already in the stage of advanced nephropathy.

Objective To investigate the methods and techniques for organ procurement from Chinesefirst category infant donation after cardiac death，and to evaluate post-transplant outcomes. Methods In this retrospective study, clinical data of 6 cases of Chinese first category infant donation after cardiac death organprocurements were analyzed Modified epigastric multivisceral organ harvesting were performed in all of thecases. Results The average warm ischemia time was 2 minutes（1.0 ～ 3.6 minutes）with the average procurementtime of 46 minutes（36 ～ 58 minutes）. Six livers and 12 kidneys were procured followed by 6 cases of livertransplantation，6 cases of en-bloc kidney transplantation. All of the recipients were healthy for 3 ~ 16 months follow-up without primary non-function and other complications except one who underwent transplant nephrectomy due to renal vein thrombosis on post operation day 7. Conclusion Modified epigastric multivisceral organ harvesting is a safe method for organ procurement from Chinese first category infant donation after cardiac deathguaranteeing procurement of high quality of organs.

Objective To investigate the value of serum AFP，PIVKA- Ⅱ and miR-21 in hepatocellular carcinoma（HCC）. Methods A total of 90 patients with compensatory cirrhosis who hospitalized in the Department of Hepatology，Tianjin Second People's Hospital from December 2017 to June 2018 wereenrolledAll patients underwent liver（gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid，Gd - EOB - DTPA ）enhanced MRI. The patients were divided into three groups ：HCC group，high-grade dysplastic nodules（HGDN）group and regenerative nodule（RN）group，and each group had 30 patients. Their serum samples were collected and the serum levels of PIVKA- Ⅱ，AFP and miR-21 were measured. Kruskal-wallis H test was used to compare thedifferences between groups. Significance levels were corrected by Bonferroni method and pairwise comparisons were made .The index of AFP，PIVKA- Ⅱ and miR-21 was analyzed by binary logistic regression，and the diagnostic value of the above indexes for HCC was evaluated by the areas under the receiver operating characteristic curve （AUC）. Results There were no difference in AFP and PIVKA- Ⅱ level between RN and HGDN group. However， AFP and PIVKA- Ⅱ levels in HCC group were higher than those in the other two groups，and the difference was statistically significant（adjusted P ＜ 0.05）. The level of miR-21 increased gradually from the RN group，HGDN group to HCC group. There were significant differences in the serum levels of miR-21 among the three groups （adjusted P ＜ 0.05）. When measured alone，the specificity and sensitivity of AFP were 91.7% and 53.3% in the diagnosis of HCC. The specificity and sensitivity of PIVKA- Ⅱ were 93.3% and 66.7% and the sensitivity and specificity of miR-21 were 97.1% and 85.0%，respectively. The sensitivity and specificity of the combined model of APR were 93.3% and 91.7%. The AUC of AFP，PIVKA- Ⅱ，miR-21 and APR were 0.756、0.873、0.953 and 0.963，respectively. Among them，APR had the highest AUROCs. Conclusion Serum AFP，PIVKA- Ⅱ and miR-21 have a high clinical value in the diagnosis of HCC，but each has its own limitation when measured alone. The combination of the three makers is beneficial to the diagnosis and screening of HCC. 

Objective A method for interpretation of donor-specific antibody（DSA）when the donor human leukocyte antigen（HLA）typing information is unavailable but with suspected antibody-mediated rejection（AMR）was demonstrated，which may improve the accuracy of clinical diagnosis and treatment. Methods Fresh transplanted kidney tissues from two patients with suspected AMR were obtained and digested for total DNA extraction. Then HLA typings of the donor and recipient was conducted. The donor HLA typing was obtained by matching the total HLA typing information with the recipient peripheral blood HLA typing. HE staining and C4d immunohistochemistry staining of the paraffin-embedded tissues of the transplanted kidney were performed. DSA-mediated AMR wasdetermined based on the patient's clinical manifestations，pathological findings，recipient's peripheral blood HLAantibody test and HLA typing results of the donor and recipient. Results One case was diagnosed with DSA-mediated C4d-negative AMR and returned to dialysis after graft nephrectomy while the other case was not considered having DSA-mediated AMR. The patient’s condition improved after 3 d of high-dose prednisolone therapy. The patient was currently surviving with a well-functioning transplanted kidney. Conclusion The method of identifying DSA by the donor HLA typing results using the transplanted kidney biopsy tissues provides necessarytechnical support for the follow-up of kidney transplant recipients who seek care at different medical centers with unavailable donor HLA typing information. In patients with suspected AMR，HLA typing of donor and recipient，DSA interpretation，and pathological findings should be combined to make an accurate clinical diagnosis and to guide the precise treatment. 

Objective To summarize the perioperative characteristics and management of isolatedmethylmalonic acidemia after liver transplantation. Methods A total of 13 MMA patients undergoing LT wereenrolled in our study from December 2014 to December 2019，the clinical characteristics，laboratory datas，chronological changes in urine MMA levels and treatment were analyzed retrospectively. Results All the 13 caseswere diagnosed with isolated MMA. Five cases were received deceased donor liver transplantation（DDLT），and eight cases received living donor liver transplantation（LDLT）. Within the early days after LT surgery，metabolic condition fluctuated. The mean base excess of blood value and plasma bicarbonate（HCO3 - ）restored to normal graduallywithin two weeks after LT. Our study also indicated that propionyl carnitine（C3）and C3/C2 level showed markedreduction after LT. The mean urine MMA was reduced by 82.41% compared with the urine level of MMA before liver transplantation（P ＜ 0.01），but remained ＞ 63 folds higher than upper limit of normal. The two patients with renal insufficiency before LT maintained stable by adjusting the immunosuppressive regimen during the observation period. Imaging changes of the nervous system were observed in 2 cases. All patients survive to date. Conclusion LT is regarded as an effective treatment to prevent metabolic crisis of MMA，we should give closely monitor the blood gas analysis to avoid the acidosis episodes by implementing sodium bicarbonate. Personalized immunosuppressive regimen should be developed for those MMA patients with kidney dysfunction.