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 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 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 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 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 explore the association between immune therapy and the risk of rejection after liver transplantation in patients with hepatocellular carcinoma （HCC）. Methods A retrospective analysis was conducted on 11 HCC patients who received immune therapy before transplantation at Beijing Friendship Hospital from 2019 to 2025， and 70 cases reported in the literature were included. The incidence of rejection and influencing factors were analyzed. Results The rejection rate in our center's cohort was 9.1% （1/11）， which was lower than that in theneoadjuvant therapy cohort （25.0%）and the post-transplantation cohort （30.8%）in the literature. The rejection rate was significantly reduced when the interval between the last dose of immune therapy and transplantation was more than two halflives. The expression of programmed death ligand 1（PD-L1）in the graft may be related to the risk of rejection and could serve as a potential biomarker for predicting rejection. Conclusion It is recommended to wait at least 8 weeks （two halflives）after immune therapy before liver transplantation. The expression levels of programmed death receptor 1（PD-1）/PDL1 in the graft tissue can be used as potential biomarkers， but further research is needed to explore the mechanism and safe time intervas. 

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 The purpose of this study is to evaluate the potential effect of ischemia-free liver transplantation（IFLT）technology in reducing the recurrence of hepatocellular carcinoma（HCC）after liver transplantation，and to compare it with the outcomes of conventional liver transplantation（CLT）. Methods We conducted a retrospective cohort study，including 208 HBV-HCC patients who underwent liver transplantation at the First Affiliated Hospital of Sun Yat-sen University from January 1，2018，to May 31，2021. Among them，22 cases received IFLT，and the remaining 186 patients received CLT. Patients were divided into IFLT and CLT groups based on the type of surgery they received，and the tumor recurrence rate，early postoperative liver function indicators，incidence of complications，and other perioperative data were compared between the two groups. The primary endpoint was tumor recurrence，and secondary endpoints included early allograft dysfunction（EAD），andserum alanine aminotransferase（ALT）and aspartate aminotransferase（AST）levels. Results The recurrence-free survival period in the IFLT group was significantly higher than that in the CLT group（P ＝ 0.037）. The incidence of EAD in the IFLT group（4.5%）was significantly lower than that in the CLT group（26.3%，P ＝ 0.046）. The peak serum ALT and AST levels，as well as the peak total bilirubin levels，were all significantly lower in the IFLT group compared to the CLT group within seven days postoperatively. Conclusion IFLT technology helps avoid ischemiareperfusion injury（IRI）by maintaining the blood and oxygen supply to the liver graft，which reduces the risk of hepatocellular carcinoma（HCC）recurrence and improves the quality of the donor liver. IFLT is expected to become an effective strategy for reducing the recurrence of HCC after liver transplantation and improving patients' long-term prognosis.