Objective To investigate the causes of kidney graft loss in early stage （within 1 yearafter surgery） in recipients with donation after cardiac death （DCD） kidney transplantation. Methods A retrospective analysis of the clinical data of 50 recipients with early kidney graft loss after DCD donor kidneytransplantation was performed. Results 50 recipients lost transplanted kidneys. The causes of kidney loss included19 rejections（38.0%），17 deaths（34.0%）with normal transplanted kidney function，5 vascular complications of transplanted kidneys（10.0%），4 cases ofcarbapenem-resistant Klebsiella infection（8%），4 cases of primary non-functioning kidney（8.0%），and 1 case of recurrence of primary kidney disease（2.0%）. The main reason for the lossof the transplanted kidney in the recipient within 1 year after the DCD donor kidney transplantation is rejection，and the secondary cause is the death of the recipient with normal renal function，complications of the transplanted kidney，primary non-functional kidney，and drug-resistant infection. Recurrence of the primary disease of the diseased kidney was rare. Conclusion Summarizing the reasons for early graft loss after DCD donor kidney transplantationis to provides reference for organ transplant physicians to strengthen targeted prevention and treatment. Ultimately，it may increase the 1-year survival of DCD donor kidney transplantation and reduce the dissatisfaction or medicaldispute caused by patients and their families.

Objective To explore the clinical efficacy of domino liver transplantation（DLT）in the treatment of liver diseases in children. Methods This study included 3 groups of 6 patients with DLT，including 2 living donors（LD）and 1 brain death donor，3 MSUD patients and 3 DLT recipients were enrolled. Each group ofDLT donors and recipients underwent surgery at the same time. The left lateral segment was obtained from theliving donor，and the whole liver was obtained from the donation after brain death（DBD）donor，angioplasty wasselectively performed according to the blood vessel conditions of the donor liver. All patients with MSUD had theirliver removed，two patients received living donor liver transplantation（LDLT）and 1 patient received DBD donorliver transplantation. The diseased liver of DLT recipients were removed and livers from MSUD patient’s wereimplanted. Results The liver function of 3 patients with MSUD returned to the normal range within 2 weeks after operation，and the blood flow of transplanted liver was normal. In 3 DLT recipients，bilirubin basically returned tothe normal range within 2 weeks after operation，and the blood flow of the transplanted liver was normal. One of MSUD patients had portal venous anastomotic stenosis after 1 month，it was improved after balloon dilation. A patient

with MSUD had acute cellular rejection after 2 weeks and was improved with steroid bolus therapy. One case ofDLT recipient experienced acute rejection after 1 week and was improved after steroid bolus therapy. One of DLTrecipient developed lung infection after 1 week，the patient stayed in intensive care unit（ICU）for a long time，and was improved with anti-infective treatment. During the follow-up period（8 ～ 16 months），all liver transplant patients and grafts survived. Conclusion It is technically feasible to apply livers of MSUD patients as DLT donors. Favorable outcome has been achieved and it will expand the source of organs to a certain degree.

Objective To explore the risk factors，clinical features，diagnosis and treatment of biliary complications（BC） after liver transplantation. Methods The general condition， laboratory examination，radiographic data and diagnosis and treatment process of the 2 patients with BC after liver transplantation were summarized and reviewed，and the therapeutic effect of the patients was evaluated through laboratory and imagingexaminations as well as clinical manifestations during the treatment. Results Two patients with BC were treated with endoscopic retrograde cholangio-pancreatography（ERCP）and percutaneous transhepatic cholangialdrainage（PTCD） in a timely manner， their symptoms were relieved and their postoperative prognosis wasgood. Conclusion Combined with the general condition，laboratory examination，radiographic data and clinical features of the patients，early detection and timely treatment of BC have a positive effect on improving the prognosis ofpatients after liver transplantation.

Objective To investigate the efficacy and safety of preventive splenic artery ligation during liver transplantation in patients at high risk for splenic artery steal syndrome. Methods Sixty eight patients withhigh risk of spleen artery stealing（meet any points of the following is eligible，① The diameter of the spleen artery ＞ 5 mm ；② The diameter of the spleen artery / the diameter of the proper hepatic artery ＞ 1.5 ；③ The spleen volume ＞ 829 ml）were included. According to whether the splenic artery was ligated during liver transplantation，patients were divided into ligated group（22 cases）and non-ligated group（46 cases）.The clinical data of perioperative period were compared between the two groups. Results Compared with the two groups，none of the recipients inthe ligation group had splenic artery stealing after surgery，which was significantly lower than that in the non-ligated

group （21.74%），and the difference was statistically significant （χ2 ＝ 4.008，

P ＜ 0.05）。 The postoperative splenicspleen artery diameter，splenic artery diameter / proper hepatic artery diameter，and spleen volume of therecipients in the ligation group were significantly lower than those in the non-ligated group，and the differences were statistically significant（P ＜ 0.05）. The postoperative hepatic arterial flow velocity（47.53±2.17）cm/s in the ligation group was significantly higher than that in the non-ligated group（31.10±1.14）cm/s，and the difference was statistically significant（t ＝ 7.384，P ＜ 0.001）. There was no statistical difference in portal flow velocity before and after surgery between two groups. At 1 week，2 weeks and 3 weeks after liver transplantation，the levels of alanineaminotransferase and total bilirubin in the ligated group were significantly lower than those in the non-ligated group，and the differences were statistically significant（P ＜ 0.05）. Conclusion For patients at high risk of splenic artery steal syndrome，prophylactic ligation of the splenic artery during liver transplantation is safe and effective.

Objective To detect the expression of miR-423-3p in hepatocellular carcinoma tissues andcells，to explore its role in the occurrence and development of liver cancer，and to explore whether it can be used as a potential molecular target for the detection and treatment of liver cancer in liver transplantation. Methods TheStarBase V 3.0 database was used to analyze the expression and prognostic value of miR-423 in liver cancer sample tissues，and quantitative real-time polymerase chain reaction（qRT-PCR）experimental method was applied to detect the expression of miR-423-3p in 106 cases of liver cancer liver transplantation tissues and in 30 normaladjacent liver tissues. The relationship between the expression of miR-423-3p and the pathological characteristicsand prognosis of liver cancer patients undergoing liver transplantation was analyzed based on the clinical data of thepatients. Results Compared with adjacent non-tumor tissues，qRT-PCR detected that miR-423-3p expression was increased in liver cancer tissues. The analysis of clinicopathological characteristics of HCC patients showed that miR-423-3p expression was closely related to tumor-free envelope，larger tumor diameter，lower differentiation and higher TNM stage（P ＜ 0.05）. Further COX multivariate retrospective analysis revealed that miR-423-3p expression，degree of differentiation and TNM stage were independent prognostic risk factors for patients with poor prognosis（P ＜ 0.05）. Using Kaplan-Meier analysis，the cumulative survival rate of miR-423-3p overexpressing liver cancer patients was significantly lower than that of patients with low expression（P ＜ 0.01）. Conclusion Overexpression of miR-423-3p may be involved in the occurrence and development of HBV-related HCC，and it can be used as a prognostic marker and clinical target for liver cancer patients with liver transplantation.

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.

Objective To explored the application of auxiliary liver transplantation in a end-stage liver cirrhosis patient with high MELD score. Methods The preoperative liver function rating，MELD score and physicalstatus of patients were tested. The recovery of liver function and the occurrence and treatment of complications wereobserved. Results The weight of the split left liver graft with middle hepatic vein was 410 g and the ratio of graft to recipient weight was 0.82%. The liver enzymes of the recipient were the highest on the day after operation（ALT 420 U/L，AST 1 788 U/L）. On postoperative 5th day，routine contrast-enhanced CT found liver graft hepatic arterythrombosis，and conservative treatment was performed for observation. Total bilirubin level rose to a maximum of 387 μmol/L on postoperative16th day，and slowly decreased to normal 2 months after the operation. Three months afterthe operation，enhanced CT clearly showed the recovery of hepatic artery blood flow in the transplanted liver. Thepatient was followed up for 6 months with normal liver function and no other complications. Conclusion Auxiliaryliver transplantation is feasible for a liver cirrhotic patient with high MELD score，and it could be considered in the patient with performance status grade 3. It should be maximized to prevent and  treat hepatic artery thrombosis during auxiliary left liver transplantation.