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 understand the psychological feelings of parents of children with congenital biliaryatresia，and to provide the basis for the treatment and rehabilitation of such diseases. Methods Convenience sampling method selected 50 parents of children with congenital biliary atresia who were hospitalized in Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine as the research objects，and the Chinese version of the parent experience of child illness（PECI）was used to investigate and analyze the results of the survey. Results The scores of parents' perception frequency of children with congenital biliary atresia from high to low were guilt and worry〔（30.8±7.4）scores〕，unknown sadness and anger〔（19.3±6.4）scores〕，emotions（support，comfort） 〔（12.7±3.7）scores〕，long-term uncertainty〔（10.6±4.3）scores〕. The parents of children with biliary atresia with a monthly income of 3 000 yuan and below felt more guilty and worried than those with an income of more than 3 000 yuan. The difference was statistically significant（P ＜ 0.05）. The parents of children with biliary atresia who lived in the north of the Qinling Mountains-Huaihe line had a statistically significant difference in theirfeelings of emotion（support，comfort）than the parents who lived in the south of the Qinling Mountains-Huaihe line （P ＜ 0.05）. Conclusion In clinical work，medical staff should pay attention to the guilt and worry needs of the parents of children，and at the same time pay attention to the differences in the needs between different groups， especially the characteristics of monthly income and living area，so as to enhance the confidence of parents in caring for children and the ability to promote the rehabilitation of children with disease. 

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 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.