Objective To explore a common cause of delayed graft function（DGF）and its diagnosis and treatment methods. Methods One patient after renal transplantation were reported，who experience hump shape change of urine up to 2 months，and the related literature of the disease were reviewed toanalyze the causes of DGF. Results The allograft kidney transplantation patient show a hump shape change of urine，and was treated by porcine immunoglobulin of anti-human T cells，and Danshen andChuanqongqin injection improving micro circulation. Regular hemodialysis was performed to remove the body of inflammatory mediators，and water， electrolyte and acid-base balance were maintained，and infection prevention and support treatment were done. Patient was discharged as urine output was gradually stabilized about 2 000 mL，and serum creatine around 130 μmol/LConclusion Full awareness of the common causes of DGF is helpful to reduce the incidence of DGF. In case of occurrence，early blood purification and auxiliary measures should be performed，and most DGF can recover.

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 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 investigate the clinical efficacy of peptide receptor radionuclide therapy （PRRT）in patients with recurrent neuroendocrine tumors （NETs） after liver transplantation. Methods A retrospective analysis was conducted on the clinical data of 5 patients with recurrent NETs after liver transplantation who underwent PRRT from April 2023 to May 2024 in Tianjin First Central Hospital. Adverse reactions and treatment efficacy were evaluated. Results The median follow-up was 15.6 months. Among the patients，1 achieved partial response （PR），3 had stable disease （SD）， and 1 experienced progressive disease （PD）. Liver function remained stable during treatment， and no rejection reactions occurred. Grade 3 neutropenia was observed in 2 cases， while grade 2 neutropenia occurred in 3 cases. Symptomatic treatment alleviated the condition in 4 cases， but 1 case had persistent severe neutropenia， leading to treatment discontinuation. Grade 1 ～ 2 proteinuria was observed in 2 cases. Conclusion PRRT is safe and effective for patients with recurrent NETs after liver transplantation. The main side effect is neutropenia， and PRRT can be considered as one of the multimodal treatment options. 

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 evaluate the effect of preoperative B-ultrasound-leaded transversus abdominisplane block（TAPB）or erector spinae plane block（ESPB）combining with patient controlled intravenous analgesia （PCIA）on postoperative analgesia in patients undergoing orthotopic liver transplantation. Methods Forty-five patients with modified piggy-back orthotopic livertransplantation were selected. The aged was 18 ～ 64 years old. The body mass index was 18 ～ 24 kg/m2，and the ASA grade was Ⅲ～Ⅴ . They were divided into 3 groups（n ＝ 15）：preoperative TAPB group，preoperative ESPB group and regular PCIA group（C group）. In the TAPB group，after the induction of general anesthesia，ultrasound-guided two-step TAPB was performed under the bilateral costal approach. Each point was injected with a mixture drug 15 ml（0.33% ropivacaine 30 ml + dexamethasone 5 mg）. In the ESPB group，after the induction of general anesthesia，ultrasound-guided bilateral TAPB was performed in T7. Each point was injected with a mixture drug 30 ml（0.33% ropivacaine 30 ml + dexamethasone 5 mg）. Group C was a conventional general anesthesia group，no nerve block was performed. Sufentanil 2 μg/kg PCIA was used in every groups，and the visual analog scale score（VAS）was maintained ≤ 3 within 48 h after operation. Sufentanil 5 μg was intravenously injected as rescue analgesic. The intraoperative consumption of remifentanil and the requirement for sufentanil as rescue analgesic were recorded. The extubation time after operation and development of nausea，vomiting，itching and respiratory depression were recorded within 48 h after surgery. Results Compared with group C，the consumption of remifentanil and the requirement of sufentanil as rescue analgesic within 48 h after operation were both decreased in TAPB and ESPB groups. Also the time of extubation was shortened，and the adverse reactions were decrecing within two days after operation（P ＜ 0.05）. Compared with group TAPB，the consumption of remifentanil and the requirement of sufentanil as rescue analgesic within 48 h after operation were decreased in ESPB group. But there were no significant difference of the time of extubation and the adverse reactions between the two groups within 48 h after operation（P ＞ 0.05）. Conclusion Preoperative ultrasound-guided TAPB or ESPB combining with PCIA can both provide better efficacy of postoperative analgesia with fewer adverse reactions in patients undergoing orthotopic liver transplantation. Compared with TAPB，the consumption of postoperative intravenous analgesic is decelerated in ESPB. 

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 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.