Objective To conclude the selection and management of brain death organ donor and the effect of cardiac transplantation on single central. Methods 110 cases heart failure patients received orthotopic heart transplantation from single central between January 2014 and June 2016. There were 86 male patients and 24 female patients. The average age was（34.5±12.7）years old，the average body mass was（52.7±14.9）kg. Therewere 84 cases diagnosed as dilated cardiomyopathy，4 cases as serious valve disease，22 case of serious ischemiccardiomyopathy. The heart function of all patients was grade NYHA Ⅲ or Ⅳ . The preoperative echocardiography showed left ventricular end-diastolediameter was（72±9）mm，the left ventricular ejection fraction was 12%-35%，the artery pulmonary pressure was 30-78 mmHg（1 mmHg ＝ 0.133 kPa），total pulmonary resist pressure was less than 48 kPa·s/L. The donors age were 21-45 years old without any cardiovascular disease or other diseases history of other major organs. The ischemic time of the donor hearts were（165±18）mins. The mean aortic clamp time was（72±18）mins. Cyclosporine A，MMF and prednisone were used as anti-immune response strategy. Results Postoperative complications included 9 cases of right heart failure，13 renal dysfunctionand 6 cases acute immune rejection. Totally 8 patients died in the perioperative period，in which 3 cases of heart dysfunction，2 case of serious infection and 3 cases of multiple organ failure. Conclusion The restrict brain death donors selection and management is the key point of success of heart transplantation，due to the serious changes in the nervous system and endocrine system of brain death donor.

Objective To investigate the clinical features of kidney transplantation of small pediatric donors into pediatric recipients. Methods A retrospective analysis of clinical data and follow-up status in50 kidney transplants from small pediatric donors into pediatric recipients was performed. Results Based on their transplantation type，the patients were divided into two groups: the single kidney transplantation （SKT, 37 cases）group and the en bloc kidney transplantation（EBKT，13 cases）group. In SKT group，postoperative complications included vascular thrombosis in 1 patient（2.7%），ureteral stenosis in 1 patient（2.7%），delayed graft function（DGF）in 17 patients（45.9%）and acute rejection（AR）in 4 patients （10.8%）. In EBKT group，postoperative complications included vascular thrombosis in 4 patients（30.8%），urine leak in 2 patients（15.4%），DGF in 2 patients（15.4%）and acute rejection in 2 patients（15.4%）. At last follow-up，patients survival rates were 100% in both groups，whereas grafts survival rates were 94.6% in SKT group 3-31 months and 76.9% in EBKT group（4-44 months）. At last follow-up，the mean serum creatinine in SKT and EBKT groupwere（67.9±23.1）μmol/L and（56.2±18.7）μmol/L，respectively. Conclusions Favorable outcomes can be obtained from transplantation from small pediatric donors. The use of this donor population for pediatric recipients should be encouraged.

Objective To investigate the protection of renal function for cardiac death donor. Methods The clinical data of 268 patients with controllable cardiac death organ donation（DCD）from the Armed Police General Hospital between September 2013 and June 2016 were analyzed retrospectively and the individual treatment was summarized and analyzed. Results In 268 donors，46 patients with oliguria and 134 patients with low plasma albumin. These patients have been positive treated with rehydration and albumin for expanding blood volume and correction of hypoproteinemia and maintain central venous pressure（CVP）at 8-12 mmHg（1 mmHg ＝ 0.133 kPa）. The urine output increased before surgery compared with the previous by treatment in 15 patients，total effective rate was 32.6%. In 85 patients who were using the vasopressor，the dosage of norepinephrine was decreased，and the serum creatinine levels was decreased in 11 of the 15 patients with highcreatinine at admission，the effective rate was 73%. Conclusion In the case of monitoring CVP，the positive fluid infusion volume is beneficial to the protection of renal function.

Objective To discuss the clinical diagnostic criteria of brain death. Methods The brain death diagnosis was made in 12 patients who were in irreversible and unresponsive coma of identifiable cause. Thepotential reversible coma due to any damage or confounding factors was also excluded. The full clinical examinationof patients demonstrated irreversible and unresponsive coma，absence of brain stem reflexes，and apnea. Theessential findings of the ancillary test verifying brain death were as follows: Short Latency Somatosensory Evoked Potentials（SLSEP）from median nerve stimulation indicated that N9 and/or N13 waves were present，but no wavesfollowing P14，N18 and N20 were recordable. Electroencephalography（EEG）showed the absence of electrical activity. Transcranial Doppler Ultrasonography（TCD）confirmed brain death by small systolic peaks in early systole without diastolic flow，or reverberating flow in both anterior and posterior circulations. The patients demonstrated positive results at least two of the above three tests. Patients were diagnosed with brain death after the first round of confirmation was completed when the results of clinical examination and ancillary tests all met the diagnostic criteria for brain death. A second clinical examination and repeated ancillary tests were carried out 12 hours after the first round of confirmation，and the results still met the standards and then brain death was confirmed. Results Twelve patients all met the diagnostic criteria of brain death. Conclusion Clinical diagnosis of brain death is a highly rigorous and scientific work. Medical professionals must closely and strictly follow the brain death criteria to determine brain death.

Objective To explore the deference expression of genes related with acute rejection（AR）by gene array，in order to provide experimental evidence for improve the level of early diagnosis and the efficacyof renal transplantation. Methods The peripheral blood were collected at the day of operation and kidneypuncture biopsy and were served as the control sample and lab sample，

total RNA were extracted，cDNA probe weresynthesized by reverse transcription，array hybridization were implemented，differentially expressed genes werescreened. Results The study discovered immune gene in peripheral blood lymph cell which was possibly relatedwith AR，there were 20 up-regulated and 11 down-regulated immune associated gene differential expression in

peripheral blood lymph cell. Conclusion There were immune gene with AR may be related in perioheral blood lymph cell and the immune gene whose express-dose appears difference at the AR has been filtered.