Objective To analyze the CT findings and clinical significance of severe non-neoplastic arterioportal shunts（APS）in the liver graft after liver transplantation. Methods From January 2004 to March2014，two receptors suffered severe liver non-neoplastic APS and were detected by follow-up CT scans in third affiliated hospital. Combined with the clinical features，Doppler ultrasound and clinical outcomes，the CT findings and clinical effects of APS on the grafts were retrospectively analysed. Results The first branches and their distal branches of the portal vein were significantly enhanced in the contrast-enhanced hepatic arterial phase in both of the two patients，and the enhancement was higher than that of the superior mesenteric vein and splenic vein. In bothof the cases，significant transient enhancement of hepatic parenchyma was also detected around APS in hepatic arterial phase. In Case 1，a doppler ultrasound showed the hepatofugal flow in the left portal vein. Chronic rejectionwas confirmed by the liver biopsy. Reduced blood supply of the hilar bile ducts was detected by a contrast-enhancedultrasound. After received anti-inflammatory，anti-rejection and liver protection therapy，APS in the liver wasdisappeared in the followed CT scans. The hepatopetal flow in the left portal vein and recovered biliary blood supply were showed in the followed ultrasound. Case 2 was a patient with iatrogenic APS occurred during the interventionalprocedure of severe hepatic artery stenosis. One years later，APS still existed in the follow-up CT scan，with obvious ischemic cholangitis. Conclusion After liver transplantation，graft rejection may also be a reason for severe APS.And when amounts of hepatic arterial blood flow to the portal vein system，the receptor may suffer not only severeportal hypertension，but also may suffer ischemic bile duct injuries.

Objective To investigate the value of diffusion-tensor imaging（DTI）and blood oxygenlevel-dependent（BOLD）in differentiation acute rejection（AR）and acute tubular necrosis（ATN），and to explorea sensitive，noninvasive strategy of evaluating renal allograft function. Methods A total of 51 renal allograftrecipients at 2-3 weeks after transplantation in Tianjin First Center Hospital were included in this study from May 2012 to March 2014 and they were examined using a fat-saturated echo-planar DTI and GRE-BOLD sequence in oblique- coronal orientation at 3.0 Tesla magnetic resonance（MR）imager（diffusion directions ＝ 6，b ＝ 0.300 s/mm2）.All patients were divided into three groups: normal renal function group，acute rejection group and acute tubularnecrosis group，and the AR and ATN groups were confirmed by pathological biopsy. Mean apparent diffusioncoefficient（ADC）and mean fractional anisotropy（FA）and apparent spin-spin relaxation rate（R2*）values of thecortex and medulla were determined separately and comparisons of parameters between the 3 groups were tested byone-way ANOVA analysis. Meanwhile，the receiver operating characteristic（ROC）curves was used to compare the differential diagnostic efficacies of every parameters in AR group and ATN group for determine the best diagnosticthreshold. Results Compared with normal group，mean ADC value in cortex，mean ADC value in medulla and medullary R2* value of AR group were significantly lower〔mean ADC value in cortex（×10-3mm2/s）：2.31±0.49 vs.2.85±0.28，mean ADC value in medullar（×10-3mm2/s）：2.21±0.50 vs. 3.07±0.38，medullary R2* value（1/s）：19.5±3.3 vs. 22.7±3.3，all P ＜ 0.05〕. Compared with ATN group，mean ADC value in cortex，mean ADC value in medulla and medullary R2* value of AR group were significantly lower〔mean ADC value in cortex（×10-3mm2/s）： 2.31±0.49 vs. 2.85±0.27，mean ADC value in medullar（×10-3mm2/s）：2.21±0.50 vs. 2.76±0.35，medullary

R2*value（1/s）：19.5±3.3 vs. 23.6±2.8，all P ＜ 0.05〕. There were no significant differences of mean cortical R2* value，mean FA value in the cortex and medulla among the three groups（P ＞ 0.05）. ROC curves revealed that the cut-off values of cortical ADC，medullary ADC and medullary R2* in differentiation AR and ATN were2.68×10-3 mm2/s，2.73×10-3 mm2/s and 21.4/s respectively. Both sensitivity and specificity were higher than 70%. The three parameters had comparable power in differentiating ATN and AR allografts（P＞0.05）. Conclusion DTI and BOLD can identify transplanted renal AR and ATN noninvasively，and mean R2* value in the medulla，mean ADC value in the cortex and medulla can be used as index for differentiating.

Objective To discuss the left renal vein anatomy at multi-detector row CT and the implicationsfor living renal transplantation. Methods The left renal vein anatomy and the branches in 79 living renal transplantation donors who underwent contrast-enhanced CT angiography were analyzed retrospectively in this study. Maximum intensity projection, curve planar reformation and volume renderings were used for displaying the left renalvein anatomy. Anomalies of left renal vein and branches were recorded and classified. Results Left renal veinswere all visualized on late arterial and venous phase CT images in all subjects. There were one case of circumaortic renal vein（n ＝ 1）and one case of left inferior vena cava（n ＝ 1）. 0 or 1 adrenal vein，0 to 2 lumbar veins and 0 to2 gonadal veins were found in each donor. Conclusion Among the left renal vein branches, the number of lumbar vein varied more frequently，multiple gonadal veins were detected in some subjects. Left renal vein branches shouldbe handled carefully to avoid massive haemorrhage in left nephrectomy.

Objective To evaluate the safety and efficacy of a transhepatic dilation protocol involving theuse of a combined cutting and conventional balloon protocol in the management of anastomotic biliary strictures in adult liver transplant recipients. Methods From October 2014 to October 2015，10 adult transplant recipientsundergoing transhepatic cutting balloon dilation and conventional balloon for anastomotic biliary strictures or occlusion in Tianjin First Center Hospital were dissected retrospectively. 10 patients'（8 male and 2 female）ages wereranging from 34 to 64 years old，mean age was 50.8±9.89 years old . The clinical features，imaging examinations，complications of interventional treatment and prognosis were reviewed. Results The technical success rates andclinical success rates of dilation regimens for stenoses or occlusion were 100% and 90%，respectively.1 patients whose anastomotic biliary strictures had not improved retented drainage tube for 12 monthes. The others retented drainagetube for 3 - 6 monthes（4.33±1.22 monthes）. The follow-up was 5-16 months post-operation. In addition，no major traumatic complications（ie，pneumothorax，infection and hemobilia requiring blood transfusions）were encountered，Blood stains were found over the cutting balloon in 4 patients. Conclusion The use of cutting balloons andonventional balloons is safe and efficacy and can increase the technical success rate for anastomotic biliary strictures in adult liver transplant recipients.

Objective To evaluate the feasibility and effectiveness of endovascular treatment of the transplant renal artery anastomotic pseudoaneurysm using chimney technique. Methods Three patients diagnosed with transplant renal artery anastomotic pseudoaneurysm were treated by chimney technique from June 2015 to October 2015. The clinical data and follow-up records were retrospectively analyzed. Results All the three patients were successfully treated by chimney technique. No interventional operation related complications occurred. Post-procedure angiography showed that anastomotic pseudoaneurysm had been completely sealed and blood supplied to transplant kidney was not obstructed. One patient had post-transplant infection before interventional procedure and died at 15 days after interventional operation. The other two patients were comfortable during the follow-up，the reexamination of CTA showed that pseudoaneurysm sac was significantly deflated，blood supply to transplant kidney was good，and the renal function was back to normal level. Conclusion Chimney technique could be an option forthe endovascular treatment of the transplant renal artery anastomotic pseudoaneurysm for saving the transplant kidneyblood supply，but the effectiveness should be confirmed by large sample studies with long-term follow-up.

Objective The study the morphology and pathology of autologous blood cell from patients withtumor during liver transplantation. Methods Among 124 patients who underwent orthotopic liver transplantation，55 patients with tumor were enrolled. Intraoperative autologous blood recovery apparatus（Cell Saver 5 or 5+）was used to collect autologous blood cell. The red blood cell volume of fully automatic washing was 225 ml/cycle. The recycled autologous blood cell was detected by smear analysis and the pathologyof recycled autologous blood cell was observed. Results Among the 55 patients with preoperative tumor，36 patients didn't receive fully automaticwashing because of less blood lose. The other 19 patients' total volume of recycled autologous blood cell was 225 ml - 13 900 ml. There were 7 patients who didn't receive autologous blood cell infusion because of blood lose less than 1 000 ml. Among 12 patients whose blood lose more than 1 000 ml，6 cases whose recovery blood cell was much enough to receive fully automatic washing for more than 5 times. At last，there were 10 patients received autologousblood cell infusion while 2 patients were suspected tumor rupture during procedure didn't receive autologous bloodcell infusion. All the red blood cells showed normal morphology in blood sample smear analysis，and no tumor cells were found in pathological examination. Crushed neutrophils were found occasionally，lymphocytes can be observed rarely. Low power light microscope，liver cancer cells arranged in a trabecular，solid nests，pseudoglandular or acinar structures，cells arranged in three or four layers thick trabecular or cords. At high magnification，the size of the cancer cells varied，morphology of the cancer cells weird，abundant acidophilic cytoplasm，round andhyperchromatic nucleus，nucleolus clear，mononucleated or multinucleated，osteoclastic-like giant cells were observed，occasionally. Conclusion In the samples of recycled autologous red blood cell，no tumor cell was found in the aspects of blood cell morphology or tumor cell pathology. he autologous transfusion can be used for the patients whose blood lose more than 1 000 ml and rupture of the tumor did not during operation.

Objective To evaluate the therapeutic results of vascular plug-assisted retrograde transvenousobliteration（RTO）for treatment of splenic and renal shunt vein following liver transplantation. Methods 3 patients who had undergone vascular plug-assisted RTO were etrospectively evaluated from August 2015 to February 2016. Percutaneous transhepatic angiography of the portal vein was performed in all patients，and then retrograde transvenous placement of a vascular plug in the shunt vein. The clinical data，imaging follow-up data，complications of interventional treatment and prognosis was summarized. Results In all patients，the percutaneous transhepatic angioplasty and placement of the vascular plug successfully，with no procedure-related complications. Follow-up CT after vascular plug-assisted RTO showed complete thrombosis of shunts in all patients，follow-up ultrasonicdoppler within 1 week and 1 month the portal vein blood flow increase obviously. 1 patient received second liver transplantation because of the biliary tract complications. Improvement in Child-Pugh score was observed in the other two patients 1 month after vascular plug-assisted RTO. Conclusion Vascular plug-assisted RTO is technically safe and seems to be clinically effective for treatment of splenic and renal shunt vein post-transplantation.

Objective To summarize the dietary guidance for patients who are undergoing follow-up afterliver transplantation. Methods Dietary guidance were conducted in a total of 82 cases of liver transplantationpatients with postoperative follow-up dietary guidance，diet principle is the low salt，low sugar，low fat，high vitamin and right amount of high-quality protein（animal protein），eating little but often throughout the day. Through the exercise along with that kind of diet，the increasing range of weight should be controlled within10 kg. Results The quality of life of patients undergoing follow-up has greatly been improved，the increasing range of weight were controlled within 10 kg and the blood concentrations of immunosuppressants were within the relatively ideal scope. Conclusion The effective health education and the right dietary guidance，which help maintain the physical and mental health of patients who are undergoing follow-up after liver transplantation，reduce the rates of patients' infection and complications and protect the function of transplanted livers are important parts of the treatment after liver transplantation.