Objective To evaluate the prognosis of patients combined with acute（subacute）hepatic failure and hepatic encephalopathy after artificial liver treatment. Methods The clinical data of 25 patients who received artificial liver treatment were collected. Parameters including total bilirubin，albumin，prothrombin activity and blood ammonia before and after treatment were collected. Total bilirubin clearance rate（TBCR），total bilirubin actual resident ratio（TBARR），total bilirubin rebound rate（TBRR）and ΔMELD score were compared. Results The Prothrombin activity and ammonia clearance were higher in the improvement group，the TBARR，TBRR and ΔMELD score were lower in the improvement group compared with deterioration group，the differences were statistically significant（P ＜ 0.05）. There was no difference between the two groups in albumin ，blood ammonia and MELD score. The AUC of TBARR、 TBRR and ΔMELD was 0.794、0.816、0.897. Conclusion TBARR，TBRR and ΔMELD could predict the prognosis of patients with artificial liver treatment ，of which Δ MELD could predict the prognosis more precisely.

Objective To explore the effect of local normothermic perfusion on the repair of donation after cardiac death porcine livers. Methods 45 kg Bama minipigs（n ＝ 3）were used in V-A extracorporeal membrane oxygenation（ECMO）perfusion after anesthesia. The devices were drained from the jugular vein，perfused through the iliac artery，and the balloon blocked the thoracic aorta，the device was started after 30 min of cardiac arrest at the temperature of 37℃ . The venous blood oxygen saturation was maintained between 60% and 70% by adjusting the flow rate of circle blood in 4 h of machine perfution. Blood gas and biochemical parameters were detected every hour. Livertissue was obtained before and after perfusion for H&E staining. Results During the 4 h perfusion，the equipment operated stably. Lactic acid was decreased significantly（P ＜ 0.05），and bile was produced all the time. The alanine aminotransferase，glutamyl transpeptidase and total bilirubin were not significantly different（P ＞ 0.05），aspartate aminotransferase concentration in the normal range. The pathological scores were extremely significance different between before and after perfusion（P ＜ 0.01）. Conclusion This study proved that local normothermic perfusion can repair the DCD porcine livers with 30 cardiac arrest.

Objective To explore the treatment value of transjugular introhepatic portosystemic shunts （TIPS）as the bridge to liver transplantation for the patients with acute variceal bleeding and decompensate liver cirrhosis. Methods The clinical data of the 21 patients with acute variceal bleeding who received TIPS at The First People’s Hospital of Foshan between January 2015 and December 2019 were analyzed retrospectively. Results Among the 21 patients，19 cases were male，2 cases were female. The median age was 52 （41 ～ 67）years. There were 15 cases in the TIPS group，6 cases in the TIPS plus liver transplantation group. Cover stent was used in all patients. TIPS treatment decreased the portal vein pressure significantly（7 cmH2O to 24 cmH2O） （1 cmH2O ＝ 0.098 kPa）. The median follow up time was 37.5 months for the TIPS group，and 27 months for the TIPS plus LT group respectively. There were 4 cases with hepatocellular carcinoma in the pure TIPS group ，one died of tumor recurrence and acute variceal bleeding recurrence in the TIPS group. Two cases had tumor recurrence. One case had new occurrence of hepatocellular carcinoma after TIPS treatment in the TIPS group. The patients lived wellin the TIPS plus liver transplantation group. Conclusion TIPS was with significant treatment value for the patients with acute variceal bleeding of decompensate liver cirrhosis，and TIPS also deserved as a bridge treatment for liver transplantation.

Objective To investigate the donor risk factors for post-liver transplantation infection in donation after the death of citizens. Methods A retrospective analysis of the clinical data of 100 patients from January 1，2015 to December 31，2019 at Zhongshan People's Hospital was performed. The patients accepted organ donation after the death of citizens for liver transplantation. The patients were divided into infection group and non-infection group according to the postoperative infection status of the patients. Univariate analysis was performed on possible factors related to donor-associated infection after liver transplantation，and related factors were included in multivariate logistic regression. Predictive or risk assessment of infection after liver transplantation were analyzed. Results The univariate analysis revealed that the donor albumin ratio，donor total bile acid and donor albumin score were related to infection after liver transplantation（P ＜ 0.05）. Multivariate logistic regression analysis showed that donor total bile acid and donor albumin scores were independent related factors for infection after liver transplantation（P ＜ 0.05）. Conclusion Low donor total bile acid and donor albumin scores before surgery were associated with lower risk of infection after liver transplantation.

Objective To observe the clinical effect of plasma exchange（PE），double plasma molecular adsorption system（DPMAS）and molecular adsorption recycling system（MARS）in the treatment of acute-onchronic liver failure，and to find the best way for the treatment of liver failure. Methods From January 2017 to December 2018，66 patients with acute-on-chronic liver failure who underwent liver transplantation in our hospital were analyzed retrospectively. According to different treatment methods，they were divided into PE group（23 cases）， DPMAS group（23 cases）and MARS group（20 cases）. The clinical data of all patients before and after treatment were collected and analyzed. Results The effective rate of MARS group was 90.0%，higher than that of PE group and DPMAS group（52.2% and 56.5%）. The difference was statistically significant（P ＜ 0.05）. There were significant differences in white blood cell，hemoglobin and platelet counts between the three groups before and after treatment （P ＜ 0.05）. In PE group，international normalized ratio（INR）and prothrombin activity（PTA）were significantly improved after treatment（P ＜ 0.05）. The liver function indexes of the three groups were improved after treatment， and MARS group was the most obvious（P ＜ 0.05）. Conclusion There are advantages and disadvantages in the three kinds of artificial liver treatment modes，of which MARS is the best one. The treatment mode should be selected reasonably according to the patients' condition in clinical work.

Objective To offer rational of blood transfusion during liver transplantation by an analysis of perioperative blood transfusion in 132 patients with liver transplantation. Methods The blood transfusion in 132 liver transplantation patients from 2013 to 2017 were researched retrospectively，the effect of preoperative laboratory parameters and diverse primary diseases on perioperative blood transfusion in patients with liver transplantation were studied. The relationship was analyzed between perioperative blood transfusion and preoperative laboratory parameters. The amount difference of intraoperative blood transfusion was compared between groups of different primary diseases. Results The frequency of blood transfusion of 132 patients with preoperative，intraoperative and postoperative liver transplantation were 10%，100% and 98% respectively，the ratio of red blood cell and plasma were 1.94 : 1，0.63 : 1 and 0.27 : 1，and the results showed that the amount of intraoperative blood transfusesion was associated with factors including direct bilirubin，total bilirubin，hemoglobin，activated partial thromboplastin time， thrombin time and thromboela-stogram results. Conclusion The primary disease and preoperative laboratory index of patients with liver transplantation should be considered，and the blood ingredients could be prepared properly before operation to guarantee the operation would get on well and to avoid the waste of blood at the same time.

Objective To investigate the factors and treatments of pneumocystis jirovecii pneumonia in recipients who underwent organ transplantation. Methods We retrospectively analyzed the frequency and characteristics of pneumocystis jirovecii pneumonia in 14 recipients who received liver or kidney transplantation between January 2017 and June 2019 in Tianjin First Central Hospital and evaluated the risk factors and therapy of pneumocystis jirovecii pneumonia after solid organ transplantation. Results There were 14 cases of pneumocystis jirovecii pneumonia after liver or kidney transplantation, 12 patients’condition improved after timely treatment. 1 patient died from multiple organ failure. Conclusion Early sufficient compound sulfamethoxazole combined with caspofungin have a good therapeutic effect.

Objective To investigate the effect of microbiological culture-positive donor liver on recovery and prognosis after liver transplantation. Methods Ninety-one liver transplant recipients receiving organ donation from adult citizens with microbiological examination data of donor liver after death were screened out from our center between July 2016 and March 2017 using a retrospective case-control study. Microbiological culture results of donor liver tissues and preservation solution were analyzed. According to culture results，recipients were divided into positive group and negative group. Based on different specimens，the positive recipients weredivided into liver tissue-positive group，preservation solution-positive group and liver tissue- and preservation solution-positive group. The presence of the same infected pathogens after liver transplantation was analyzed. Hospital stay and perioperative mortality after transplantation were compared among different groups. Results In the 91 cases of donors and organ preservation solutions，there were a total of 26 cases showed positive culture results. Among them，17 cases showed positive culture results in both donors and organ preservation solutions， 4 cases presented positive culture results in only liver tissues and 5 cases demonstrated positive culture results in only preservation solutions; 7 cases showed positive in both bacterial and fungal culture，13 cases presented positive in only bacterial culture and 6 cases demonstrated positive in only fungal culture. Among 20 cases of positive bacterial culture，gram-negative bacteria was found in 11（55%）cases and gram-positive bacteria in 9（45%）cases. Gram-negative bacteria and gram-positive bacteria were not detected at the same time. As for bacterial colonization，the top three were baumanii，klebsiella pneumonia and enterococcus faecalis，respectively. As for fungal colonization，the top three were Candida albicans，Candida tropicalis and Aspergillus，respectively. Among the recipients with liver transplantation，8 recipients showed perioperative death，5 were positive with microbiological examination. In the positive group，infection was confirmed in 6 cases after transplantation，presenting an incidence of 23.1%，and death occurred in 2 cases，with a mortality of 33%. In the positive group，there were 7 recipients with both fungi- and bacteria-positive，among which 4 recipients died after transplantation（mortality ：57%），including 1 recipient who died from infection and 3 recipients who died from multiple organ failure caused by poor recovery of liver function. Hospital stay after transplantation was（27 ± 16）d in the positive group and（17 ± 7）d in the negative group（P ＜ 0.05）. Perioperative mortality rate was 19.2%（5/26）and 4.6%（3/65）in the positive group and the negative group，respectively（P ＜ 0.05）. Conclusion Bacterial or fungal colonization in donor livers and their preservation solutions is not directly related to infection after liver transplantation，but it is significantly correlated with donor-derived infection，delayed recovery of donor liver after transplantation，and prolonged hospital stay after transplantation. Donor livers with fungal colonization combined with bacterial colonization show significantly increased mortality rate after liver transplantation.