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 role of fission protein 1 （FIS1） in affecting renal ischemiareperfusion injury by regulating mitochondrial division and apoptosis. Methods Probing FIS1 expression levels and apoptosis levels were measured at different times in the renal tubular epithelial cell（ HK-2）with hypoxiareoxygenation（ HR）model and mouse renal ischemia-reperfusion（ IR） model. Cell lines with FIS1 knockdown and overexpression were constructed，changes in the degree of mitochondrial division were observed using mitochondrial probes，and changes in the level of apoptosis were detected with flow cytometry. Results FIS1 knockdown/ overexpression had essentially no effect in normal cells. After HR， knockdown of FIS1 inhibited mitochondrial division and reduced apoptosis levels， and vice versa after overexpression of FIS1. Conclusion In IRI， Inhibition of FIS1 expression reduces mitochondrial division and reduces the level of apoptosis， which is expected to be a potential therapeutic target for IRI. 

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 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 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 evaluate the immunogenicity of the DNA ligand of DNA immunoadsorbent by observing the serum antibody production，lymphocyte proliferation and changes in immune organ and tissue in rabbits. Methods Twenty-four healthy rabbits were randomly divided into high-dose DNA group，low-dose DNAgroup，low-dose DNA + adjuvant group，and blank control group，with 6 rabbits in each group. Serum antibody titer was determined by the methods of double agar diffusion and enzyme linked immunosorbent assay（ELISA）. The liver and kidney tissues were collected for pathology observation. The spleen was collected to isolate the lymphocytes，which were divided into double strands DNA experiment group，nonspecific immunostimulator concanavalin（ConA）positive control group and cell culture fluid negative control group. The lymphocytes were cultured in vitro with the peripheral blood lymphocytes of rabbit. Spleen lymphocyte proliferation was observed by methylthiazolyl tetrazolium （MMT）colorimetry. Results The double agar diffusion results showed that double stranded DNA could not stimulate the immune system to produce antibodies in rabbits. ELISA results showed that double stranded DNA hadno immunogenicity，which could not stimulate the production of corresponding antibody（F＝1.183，P＝0.341）.The number of splenic lymphocyte proliferation（A value）in negative control group，DNA experiment group，and positive control group were 0.241±0.040，0.850±0.070，0.576±0.078，respectively，but there were no significantdifferences among three groups（F＝1.183，P＝0.336）. No pathological change and lymphadenosis was found byhistopathology results. Conclusions The DNA ligand of DNA immunoadsorbent cannot stimulate rabbits to producespecific antibodies，nor stimulate the lymphadenosis in immunized rabbits. The DNA ligand has no immunogenicity.

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.