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 explore the impact of tumor recurrence to long term survival after live transplantation. Methods We retrospectively analyzed the clinical data of 101 cases with liver tumor after liver transplantation between January 2007 and December 2009. The end of follow-up data was December 2012，and the data of dead patients were analyzed. Results The one year survival rate after liver transplantation of malignant tumor patients was about 80%，and the three years survival rate was about 70%. Follow up to December 2012， 35 cases were dead. The first important reason to lead patients dead was tumor recurrence，and the rate was 45.7%. The next reason was hemorrhage，with the rate of 28.6%. Conclusions Tumor recurrence has already been thought to be the significant element impacting the long term survival of liver transplant recipients with primary malignancy. And the clinical emphasis has lied on the prevention of the tumor recurrence and decreasing its rate.

Objective To study the changes in the level of serum proteins and amino acids in rats performedpartial hepatectomy when portal vein was fully arterialized，and to explore the effect on protein synthesis and amino acid metabolism in the liver by portal vein arterializations（PVA）. Methods The rat model of PVA was established using cuff technique. Twenty of the Sprague-Dawley rats in each group were randomly selected. Rat models in group A were those with portal vein arterialization combining 40% liver resection and left nephrectomy，those in group B were with 40% hepatectomy with left nephrectomy，and those in group C were performed the left nephrectomy alone . On the third and seventh day after operation，the levels of serum amino acid profile were analyzed by automatic amino acid analyzer. Results The success rate of group A was 93.3%（28/30），and that of group B and C were both 100%. Serum amino acids ：Ⅰ：3 days after surgery，Ala，Tyr，Phe，Lys in group A and B compared with group C increasedhighly ；Val，Ile，Leu，Arg，Trp，BCAA/AAA in group A and B compared with group C decreased highly，all of the difference had statistically significant（all P＜0.05）. Comparing with group B，Val in group A decreased highly ； Leu and Lys increased highly，with statistically significant difference（all P＜0.05）；while no statistically significant difference had been found in other parameters（all P＞0.05）. Ⅱ：7 days after surgery，Ile，Leu，Arg，Trp，BCAA/ AAA in group A comparing with group B increased highly，Tyr，Phe decreased highly ；when comparing with group C，Ala，Lys increased highly，and all of the difference was statistically significant（all P＜0.05）. Ala，Tyr，Phe，Lys in group B comparing with group C increased highly, and Ile，Leu，Arg，Trp，BCAA/AAA decreased highlywith statistically significant difference（all P＜0.05）. As far as the changes of other amino acids were concerned, no statistically significant difference had been found between each other group（all P＞0.05）. Conclusions The levels of amino acids recover effectively after portal vein arterializations，and the arterialized group is better than the non-arterialized group. The portal vein arterialization can enhance the accommodation of amino acid in the early period after hepatectomy.

Objective To discuss the feasibility and effect of extracorporeal membrane oxygenation（ECMO）during inter-hospital transport of potential donors after cardiac death（DCD）. Methods The clinical data of one case of inter-hospital transport of potential donors after cardiac death requiring extracorporeal membrane oxygenation support were analyzed retrospectively. Results A potential donor was performed inter-hospital with central circulatory collapse caused by brain injury. The patient was previously cannulated on ECMO prior to transport and transported a distance of about 120 kilometer to our institution by ambulance. ECMO running times were 158 minutes， and operation process circulatory stable，organ donation process is implemented by cardiac death processes in General Hospital of Guangzhou Military Command. Conclusion ECMO can ensure inter-hospital transport of potential donors after cardiac death safety.

Objective To discuss the efficacy of endoscopic retrograde cholangiography （ERC）in the diagnosis and management of bile leakage after orthotopic liver transplantation（OLT）. Methods FromJanuary 2005 to February 2013，23 patients with bile leakage after OLT who were diagnosed by means of magnetic resonance cholangiopancreatography（MRCP）or ERC. The clinical data of 23 cases with bile leakage were reviewedretrospectively，including postoperation time，the location of the bile leakage，times of ERC and whether need bilary stenting，then the clinical value of ERC was evaluated. Results We carried out a retrospective review of 23 consecutive patients with bile leakage after OLT（Male 19，Female 4），the mean age was（49.0±5.8）years old，and one case failed because unsuccessful bile duct cannulation ；Therapeutic procedures were carried out in 22 patients， which included endoscopic nasobiliary drainage（ENBD）or endoscopic retrograde biliary drainage（ERBD），cilincal success in 18 patients（three combined with peritoneal drainage，four combined with T-tube fistula drainage）， and one drainaged by percutaneous transhepatic drainage（PTCD），three received re-operation，one died because of serious hematosepsis. Conclusions ERC is an effective method for diagnosis of post-OLT bile leakage，its sensitivity and diagnostic accuracy is higher than MRCP and its theraputic effection for different types of bile leakage after OLT is cure. However，the therapeutic effect of ERC was relatively poor for some patients who suffered severesecondary bacterial infection，and whose medical prognosis gets grim.