Objective To summarize the variety of portal vein reconstruction to prevent portal veinthrombosis and stenosis in pediatric liver transplant recipients. Methods From September 2006 to March 2013，we performed 175 livertransplantations for children with end-stage liver diseases. Recipients were from 4.5 months to 12 years old，average（16.16±19.77）months. The recipients were followed up from 1 to 93 months and data were collected. 1，3 and 5-year survival rate，incidence of postoperative complications of portal vein，surgical techniqueand other relevant factors were analyzed. Results Of the 175 patients，donor portal vein to recipient portal vein branch bifurcation vein segment anastomosis were performed in 126 cases，donor portal vein to recipient confluenceof superior mesenteric vein and splenic vein in 2 cases，and donor iliac vein bypass grafts were used in 5 cases.

Postoperative portal vein stenosis were not observed，and liver function recovered well. Among 42 patients underwent end-to-end portal vein anastomosis，2 cases suffered portal vein thrombosis（1.14%），one with living donor liver transplantation and the other with split liver transplantation，which were successfully treated with percutaneoustranshepatic portal vein angioplasty. Other complications included hepatic artery occlusion in 5 cases（2.9%），bileleakage in 5 cases（2.9%），postoperative intestinal leakage in 3 cases（1.7%），acute rejection in 7 cases（4.0%），biliary complications in 9 patients（5.1%），and opportunistic infections in 115 cases（65.7%）. Among 175 cases of pediatric recipients with follow-up from 1 to 93 months patients，14 cases died，with 7 cases of multiple organ failure，6 cases of severe lung infection，one case of hepatic arterial bleeding. The overall 1，3，5-year survival rates were95.5%，94.7%，and 93.1% respectively. Conclusion Selection of appropriate way of portal vein reconstructionaccording to matching donor and recipient portal vein diameter and length is feasible and plays an important role on the prevention of pediatric liver transplantation portal vein stenosis and thrombosis.

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.

Objective To study the efficacy and safety of mycophenolate mofetil（MMF）in pediatric liver transplantation. Methods We retrospectively analyzed the clinical data of 18 cases of pediatric liver transplantations performed from August 2013 to August 2014 in Tianjin first central hospital，of which 12 caseswere treated with MMF. Results Among these 18 recipients，1 suffered biliary-enteric anastomosis intestinalfistula 2 weeks after operation，and no severe surgical complications were observed in other 17 cases. MMF wasadministrated in 8 cases for acute rejection and 4 cases for low tacrolimus concentration. Alanine aminotransferase （ALT）decreased significantly in those 8 recipients with acute rejection after administration of MMF（39 U/Lvs. 233 U/L，P ＝ 0.007）. Aspartate aminotransferase（AST），total bilirubin（TBil）and alkaline phosphatase（ALP）also decreased，but there were no statistically significant differences（P value were 0.05，0.19 and 0.06 respectively）.Liver function was normal in all cases till September 2014. In 6 recipients without administration of MMF，2 casessuffered EB virus infection，while in 12 recipients with administration of MMF，3 cases suffered EB virus infectionwith 2 out of these 3 with cytomegalovirus infection. 1 case suffered MMF-induced diarrhea. Bone marrow suppression was not observed in all cases. Despite the EB virus infection，no posttransplant lymphoproliferative disorders（PTLD）and other malignant tumors were observed in this cohort. Conclusion MMF is an effective immunosuppressant for treatment and prevention of acute rejection in pediatric liver transplantation without significant side effects.

Objective To compare the early graft function in biliary atresia patients after living donor liver transplantation and whole liver transplantation. Methods 22 children underwent pediatric liver transplantation for biliary atresia from January 2014 to June 2014 in Tianjin First Central Hospital. Among them，14 patientsunderwent living donor liver transplantation（LDLT group）using piggyback technique with left liver lobe，8 patients underwent whole liver transplantation without bypass（WLT group）. Pre-operative and intraoperativeclinical data and early postoperative liver function were compared retrospectively. Results There were no significant differences in age，gender，weight，preoperative Child-Pugh score，alanine aminotransferase（ALT），aspartate aminotransferase（AST），total bilirubin（TBil），direct bilirubin（DBil），intraoperative blood loss，blood transfusion，and graft weight between these two groups（P ＞ 0.05）. However，donor age was older in LDLT group〔（30.8±6.9）years vs.（8.6±6.0）months〕than that of WLT group，with longer operative time〔（11.6±1.3）hours vs.（9.2±1.5）hours〕and shorter cold ischemia time 〔（72.1±21.7）minutes vs.（458.75±127.72）minutes〕（P＜0.05 or P＜0.01）. Early after liver transplantation，ALT，AST，TBil，DBil decreased progressively（P＜0.05）. The ALT level of LDLT group（U/L ：1 294±1 127，

716.2±594.1，544.6±580.7，377.2±397.9，287.4±269.4）was significantly higher than that of WLT group（U/L ：425.0±458.3，335.0±374.5，246.7±259.7，173.0±189.2，122.2±98.31，P ＜ 0.05）on post operative day（POD）1，2，3，4，5，higher but without significant difference on POD 6 and 7（P ＞ 0.05）. There was no statistical significance in AST level between two groups（P ＞ 0.05）. The TBil and DBil levels of WLT group were higher on POD 1 ～ 4，but lower on POD 5 ～ 7 than that of LDLT group（P ＞ 0.05）. Conclusion The liver function recovered well early after operation in both groups. ALT level of LDLT group was higher than that of WLT group on POD 1 ～ 5，which was probably related to longer operative time and ischemia injury caused by operation. LDLT is being advocated as an effective method to better meet thewaiting-list needs and shorten the waiting time.

Objective To investigate the incidence of Epstein-Barr virus（EBV） infection after pediatricliving related liver transplantation and analyze related treatment and prognosis. Methods The medical records of pediatric liver transplant recipients who received living related liver transplantation because of biliary atresiaand biliary cirrhosis in Tianjin First Center Hospital during January 1，2012 and December 31，2013 wereanalyzed retrospectively，with diagnostic standard of positive blood EBV-DNA. The incidence of Epstein-Barr virus infection after pediatric living related liver transplantation and corresponding treatment and prognosis were analyzed. Results 14（16.3%）out of 86 pediatric liver transplant recipients were turned out to be EBV-DNApositive in blood，which were defined as EBV infection，9 cases occurred within the first 3 months after transplantation and 5 after 3 months；when therapy of reducing immunosuppressants and multi antivirus drugs were applied，a total of 13 recipients acquired favorable prognosis，and one case may turn into chronic EBV infection. Conclusion When appropriate immunosuppressants adjustment and antivirus drugs were applied，most pediatric liver transplant recipients who developed EBV infection can acquire satisfying prognosis.

Objective To report one case of reduced-size liver transplantation in the treatment of children with congenital segment reported cases of biliary atresia. Methods Reduced monosegmental liver transplantation was performed for one patient suffered congenital biliary atresia in our hospital in March 2014. Thepatient was 5 months old and 7 kg in weight. His mother donated her left lateral liver. Due to graft-to-recipientweight ratio（GRWR）was too high（5.14%），the left lateral donor liver was harvested and further reduced size invitro. The diseased liver of patient was removed with the vena cava reserved，then orthotopic liver transplantation was performed. Results Donor operative time was 6.5 hours and total amount of bleeding was 150 ml，donor recoveredwell and discharged 1 week after operation. Recipient operative time was 8.5 hours with 50 minutes of an-hepaticperiod. Reduced-size graft was 260 g and GRWR was reduced to 3.71%. Intraoperative methylprednisolone inductionand tripleimmunosuppressive regimen（tacrolimus + mycophenolate mofetil + methylprednisolone）were applied forrecipient. Recipient condition was well and liver function return to normal level 25 days after operation. Abdominalultrasound suggest normal hemodynamics and increasing volume of graft liver. Recipient was discharged 35 days afteroperation and abdominal wound healed with A level. Both donor and recipient were followed up 6 months without any complications. Conclusion To prevent complications associated with large-for-size grafts，further graft reduction could be necessary to overcome the large-for-size graft syndrome，the reduced monosegmental liver transplantationis an safe and effective selection which was based on accurate preoperative radiological assessment of the graft andexcellent perioperative care and management to the patient.