Objective To summarize the experience in the treatment of antibody mediated rejection（AMR）after kidney transplantation. Methods A retrospective analysis was conducted on kidney transplant recipients who was diagnosed as AMR by biopsy in the Third Medical Center of the General Hospital of the People's Liberation Army from 2018 to 2021. Regular follow-up and prognosis were analyzed after treatment. The survival time of the graft between different time of rejection after transplantation，pathological type，DSA type，and number of kidney transplants were compared，and factors that may affect prognosis were preliminarily screened. Results The results showed that 14 recipients were diagnosed with AMR. After combination therapy of plasma exchange，lymphocyte depleting antibody and immunoglobulin treatment，the overall 1-year graft survival rate was 78.6%，and the 5-year survival rate was 43%. Within 6 months after treatment，3 cases with infection required hospitalization，including 1 case of cutaneous herpes zoster infection，1 case of urinary tract infection，and 1 case of diarrhea. There were nolife-threatening or graft loss case directly related to infection. Conclusion A combination treatment based on plasma exchange can achieve some effects in the treatment of antibody mediated rejection after kidney transplantation. Further research is needed on the optimization of protocols for different types of rejection. 

Objective To explore the effect and preliminary mechanism of plant extract ursolic acid（UA）inreducing hepatic ischemia/reperfusion injury（HIRI）. Methods C57 male mice were divided into sham operation group，sham operation +UA group，HIRI group，HIRI low-dose group and HIRI high-dose group. The analysis and validationwere carried out by methods such as animal experiments，network pharmacology and molecular biology. Results Animal experiments showed that UA significantly reduced the activities of AST and ALT in serum of HIRI mice. Target genescorresponding to HIRI and ursolic acid were obtained by TCMSP，Pharm Mapper，Swiss Target Prediction，GeneCards and other databases，and key target genes were obtained by DAVID，STRING and Cytoscape. They were PPARG （peroxisome proliferator-activated receptor gamma，PPARG），

MAPK3（mitogen-activated protein kinase 3，MAPK3） and PTGS2（prostaglandin G/H synthase 2，PTGS2）. Finally，PTGS2 was identified as the hub target gene in this study according to the molecular docking score and the number of hydrogen bonds binding between receptor and ligand. Compared with Sham operation group，PTGS2 was highly expressed in HIRI group（P ＜ 0.01）. Compared with HIRI group，the expression of PTGS2 in HIRI + LUA and HIRI + HUA groups was significantly decreased （P ＜ 0.01）. Conclusion UA can regulate the protective effect of PTGS2 on hepatic ischemia reperfusion injuryin mice. Thisstudy providesa reference for clinical development of new drugsto interveneHIRI.

Objective In order to explore the influence of liver regeneration on tumor recurrence after partial hepatectomy as well as the possible mechanisms. Methods Portal vein injection of 256 tumor cells suspension after partial hepatectomy was performed to simulate the tumor recurrence and metastasis . The animals were divided into three groups（H0 group， H30 group and H70 group）according to different proportion of hepatectomy. The rate of tumor recurrence， change in body weight， tumor-bearing graft weight， tumor-bearing graft to body weight ratio were comparedamong three groups after three weeks. Meanwhile， the accumulate abundance of protein CAPNS-1 and the PCNA index were utilized to judge the tumor invasiveness. Western Blot and RT-PCR analyses were applied respectively to assess the abundance of protein c-met， VEGFR-2 and mRNA. Moreover， the relation between the tumor invasiveness and the abundance of c-met，VEGFR-2 were explored. Results All rats in H70， H30 and H0 groups were alive after 3 weeks with metastatic tumor lesions in their livers. The extent of increase or decrease in general indexes， such as body weight，tumor-bearing graft weight and tumor-bearing graft to body weight ratio， were obviously in group H70. And the tumors in rats of group H70 revealed upper invasiveness and malignant potential. In addition， the H70 group displayed diffuse distribution of tumors. The level of CAPNS-1 expression and the PCNA index were evaluated in H70. The largest resection was also associated with significant up-regulation of c-met， VEGFR-2 protein and mRNA expression. Furthermore， there was a significantly correlation between the level of VEGFR-2， c-met and the change in general indexes， and the level of CAPNS-1 protein expression. Conclusion This research reveals that liver regeneration after partial hepatectomy not only can accelerate the malignant transformation， but also can promote tumor growth. 

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. 

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 elucidate the relationship between preoperative immunotherapy，the abundance of tertiary lymphoid structures（TLS）in hepatocellular carcinoma（HCC）tissues，and to evaluate patient prognosis following liver transplantation. Methods The clinical data of 149 liver transplant patients with liver cancer at Huashan Hospital Affiliated to Fudan University from January 2018 to December 2023 were retrospectively analyzed. Pathological slides of each patient were scored for TLS. Patients were categorized into four groups based on downstaging treatment outcomes ：those initially meeting the Milan criteria（n ＝ 35），those exceeding the Milan criteria without downstaging treatment（n ＝ 38），successful downstaging cases（n ＝ 33），and unsuccessful downstaging cases （n ＝ 43）. Kaplan-Meier analysis and the log-rank test were employed for survival analysis. The correlation betweenimmunotherapy and TLS abundance was assessed using non-parametric statistical methods. Results Survival analysis of the overall cohort revealed that patients with high intratumoral TLS abundance had significantly higher recurrence-free survival（RFS）than those with low TLS abundance（P ＜ 0.05）. Among patients receiving downstaging treatment，the recurrence risk in the successful downstaging group was significantly lower than in the unsuccessful group（P ＜ 0.05）. Non-parametric testing of the successful downstaging group demonstrated that preoperative immunotherapy significantly increased intratumoral TLS abundance（P ＜ 0.05）. Similarly，nonparametric testing of all patients receiving immunotherapy showed a statistically significant increase in intratumoral TLS abundance in the successful downstaging group（P ＜ 0.05）. Conclusion Successful downstaging withpreoperative immunotherapy improves the prognosis of HCC patients undergoing liver transplantation，potentially by enhancing intratumoral TLS abundance. 

Objective To investigate the clinical features of donor-derived drug-resistant Klebsiella pneumoniae infection and to summarize the experience of clinical treatment after liver transplantation. Methods Retrospective analysis was performed based on clinical data and the diagnosis and treatment of three live transplantrecipients with donor-derived carbapene-resistant Klebsiella pneumoniae（CRKP）infection in Department of Hepatobiliary Surgery，the Third Hospital of Hebei Medical University. Results Three recipients with donor-derived CRKP infection were confirmed by bacterial culture and were treated with anti-infection therapy（ceftazidine-avibactam combined with carbapenems），and one of them developed abdominal infection after transplantation withoutanti-infection therapy. After removal of abdominal abscess，ceftazidine-avibactam standard dose（3.75 g / d）was used to this recipient. The infection was not well controlled，and the patient eventually died. Standard measurement was used in another case，and bleeding occurred at the anastomotic site of hepatic artery 3 weeks after the operation. After two operations，high dose treatment（7.5 g /d）was used，the recipient and the transplanted liver survived. High doses treatment（7.5 g / d）was given to the third patient, the infection was control 4 weeks after treatment，sputum culture and blood culture were negative，the recipient and graft survived. Conclusion The infection of donor CRKP significantly increases the mortality of liver transplantation patients. The early application of ceftadiene-avibatan combined with carbapenems combined with anti-infection treatment has a good effect，and increasing the dose of ceftadiene-avibatan can improve the curative effect，without any obvious adverse reactions.