Objective To investigate the safety and efficacy of islet transplantation after failed pancreas transplantation， and to summarize the literature experience. Methods The clinical data of 3 patients with islettransplantation after failed pancreas transplantation in the first Affiliated Hospital of Sun Yat-sen University wereretrospectively analyzed and followed up for 6 months.Results In the 3 patients who received islet transplantation afterfailed pancreas transplantation， the islet function was good after operation， the level of fasting C-peptide was significantly improved compared with that before surgery. All patients stopped using exogenous insulin or reduced the dosage by morethan 2/3， and their blood glucose was stable. Conclusion islet transplantation after failed pancreas transplantation canbe a remedial treatment for diabetes mellitus with high efficacy and safety. 

Objective To evaluate the effect and safty of islet transplantation after kidney transplantation for patients with type 2 diabetes mellitus（T2DM）and end-stage renal disease. Methods One case of islet transplantation was performed on a patient with T2DM complicated with chronic renal failure who had received kidney transplantation 3 months ago. The recipient was given exgenous insulin therapy with a dose of 1.26 U/（kg·d） before islet transplantation. The islets were transplanted into the liver through interna jugular vein transhepatic portal catheterization， as TIPS approach， the portal channel was established within the main portal vein， and the islets were slowly injected into the recipient's liver at a constant speed. Anti-CD25 monoclonal antibody was used as induction and a combination ofetanercept， mycophenolate mofetil and tacrolimus were used as maintenance immunosuppression therapy. Insulin dose， the level of blood glucose， C-peptide and the value of HbA1c were observed.Results Blood glucose was normal soon afteroperation， and the exogenous insulin was suspended. The fasting blood glucose was 4.8 ~ 8.5 mmol/L and the postprandial blood glucose was 6.9 ~ 15.1 mmol/L within the first week after operation. The total amount of exogenous insulin decreased by 50.14% compared with that before operation. The value of HbA1c was 6.3% within the first week after operation（the level of HbA1c was 6.6% before operation）. The fasting and postprandial C-peptide and insulin levels increased after operation. On the 7th day after operation， insulin and C-peptide release tests were performed. The results showed that the function of transplanted islets was partially restored, and insulin secretion was rhythmic. Conclusion Islet transplantation is an effective treatment for T2DM patients with ESRD after kidney transplantation.

Objective To investigate the associated risk factors affecting the development ofposttransplantation diabetes mellitus （PTDM） and to analyze the effect of PTDM on patient outcomes. Methods We selected patients who underwent liver transplantation from DCD donors at the hepatobiliary center of the First Affiliated Hospital of Nanjing Medical University between January 2015 and September 2020. The patients were divided into PTDM and non PTDM groups， and the baseline characteristics， intraoperative information and postoperative complications werecompared between the two groups. A competing risk model was used to identify relevant risk factors affecting the occurrence of PTDM， and Cox regression was used to analyze the effect of PTDM on patient outcomes. Results The incidence of diabetes at 1，3 and 5 years after liver transplantation was 13.3%，16.9%，27.0%， respectively. There were statistically significant differences in patient age， length of postoperative hospital stay， and immune rejection between groups. Afteraccounting for death as a competing risk event，every 10-year increase in age was associated with a 45% increased risk of developing PTDM （SHR ＝ 1.45，95% CI ＝ 1.17 ～ 1.80）； The risk of PTDM in patients with immune rejection was 2.06 times higher than that in patients without immune rejection （95% CI ＝ 1.00 ～ 4.24）； Patients hospitalized for more than one month postoperatively had a 62% increased risk of developing PTDM （SHR ＝ 1.62，95% CI ＝ 1.01 ～ 2.59）. The risk of late infectious complications in PTDM patients was 2.48 times higher than non PTDM patients （95% CI ＝1.22 ～ 5.04）； Whereas the incidence of late biliary complications was not statistically different between the two groups （RR＝ 1.58，95% CI＝ 0.77～ 3.26）. After controlling for disease diagnosis， patients in the PTDM group had a 1.73-fold （95% CI ＝ 1.07 ～ 2.77） higher risk of death than non PTDM patients. Conclusion The incidence of PTDM is associated with patient age， immune rejection， and long postoperative hospitalization， and the overall survival of PTDM patients is poor， with a rising risk of late postoperative infection. After transplantation， blood glucose should be screened early to prevent PTDM， in the hope of reducing the occurrence of PTDM and improving patient outcomes.

Objective To explore the risk factors of post-transplant diabetes mellitus （PTDM） in patients with kidney transplantation， to provide evidence for the prevention and treatment of PTDM. Methods Theclinical data of 136 patients who underwent allogeneic kidney transplantation from July 2018 to July 2020 were retrospectively analyzed. The patients were divided into PTDM group （fasting blood glucose ≥ 7.0 mmol/L） andnon-PTDM group （fasting blood glucose ＜ 7.0 mmol/L） according to the domestic diabetes diagnostic criteria. Univariate and multivariate Logistic regression were used to analyze the independent risk factors of PTDM. Results Among136 renal transplant patients，47 cases were diagnosed with PTDM， and the incidence of PTDM was 34.6%. MultivariateLogistic regression analysis showed： age ≥ 45 years old（OR ＝ 3.019，95% CI ＝ 1.123 ~ 8.115，P ＝ 0.028）， body mass index （BMI）≥ 25 kg/m2 （OR ＝ 3.868，95% CI ＝ 1.253 ~ 11.941，P ＝ 0.019）， acute rejection after transplantation （OR ＝ 4.620，95% CI ＝ 1.339 ~ 15.940，P ＝ 0.015）， use of tacrolimus after transplantation （OR ＝ 4.853，95% CI ＝ 1.49 ~ 15.807，P ＝ 0.009） were independent risk factors for PTDM after kidney transplantation （OR ＞ 1，P ＜ 0.05）. ConclusionThe risk of PTDM increased significantly in kidney transplant patients with age ≥ 45 years old， BMI ≥ 25 kg/m2 ， acute rejection after transplantation and use of tacrolimus after transplantation. 

Objective In order to explore the influence of liver regeneration on tumor recurrence after partial hepatectomy as well as the possible mechanisms. Methods Portal vein injection of 256 tumor cells suspension after partial hepatectomy was performed to simulate the tumor recurrence and metastasis . The animals were divided into three groups（H0 group， H30 group and H70 group）according to different proportion of hepatectomy. The rate of tumor recurrence， change in body weight， tumor-bearing graft weight， tumor-bearing graft to body weight ratio were comparedamong three groups after three weeks. Meanwhile， the accumulate abundance of protein CAPNS-1 and the PCNA index were utilized to judge the tumor invasiveness. Western Blot and RT-PCR analyses were applied respectively to assess the abundance of protein c-met， VEGFR-2 and mRNA. Moreover， the relation between the tumor invasiveness and the abundance of c-met，VEGFR-2 were explored. Results All rats in H70， H30 and H0 groups were alive after 3 weeks with metastatic tumor lesions in their livers. The extent of increase or decrease in general indexes， such as body weight，tumor-bearing graft weight and tumor-bearing graft to body weight ratio， were obviously in group H70. And the tumors in rats of group H70 revealed upper invasiveness and malignant potential. In addition， the H70 group displayed diffuse distribution of tumors. The level of CAPNS-1 expression and the PCNA index were evaluated in H70. The largest resection was also associated with significant up-regulation of c-met， VEGFR-2 protein and mRNA expression. Furthermore， there was a significantly correlation between the level of VEGFR-2， c-met and the change in general indexes， and the level of CAPNS-1 protein expression. Conclusion This research reveals that liver regeneration after partial hepatectomy not only can accelerate the malignant transformation， but also can promote tumor growth. 

Objective To compare the BK virus infection in urine and blood of kidney transplantation recipients under the therapy of monoclonal antibody immune induction or polyclonal antibody immune induction during the same period. Methods The urine and blood BK virus DNA test results of a total of 298 patients who underwent kidney transplantation in our hospital from January 2017 to July 2019 were retrospectively collected. According to the different immune induction treatment regimens， the recipients were divided into two groups ： monoclonal antibody group with 85 cases， and polyclonal antibody group with 214 cases. The BK virus infectionresults in both groups were compared， the impact of the different immunization induction therapy on the BK virus infection in kidney transplant recipients was explored. Results The results of all the patients show that thepositive rate of urine BK virus was 50.00% （149/298）， the positive rate of blood BK virus was 3.69% （11/298）. Afterthe kidney transplantation， the positive rate of urine BK virus was significantly higher than that of blood BK virus（P ＜ 0.01）. The positive rate of urine BK virus in the monoclonal antibody group was 50.59% （43/85）， and the positive rate of urine BK virus in the polyclonal antibody group was 49.77% （106/213）， the difference was not statistically significant （χ2 ＝ 0.165，P ＞ 0.05）. The positive rate of BK virus in the blood of the monoclonal antibody group was 2.35% （2/85）， and the positive rate of BK virus in the blood of the polyclonal antibody group was 4.22% （9/213）， the difference was not statistically significant （χ2 ＝ 0.188，P ＞ 0.05）. Conclusion For the BK virus infection after the kidney transplantation， there is no significant difference between monoclonal antibody immune induction therapy group and polyclonal antibody immune induction therapy group. While the infection rate of BK virus in both groups is very high. After the kidney transplantation， strengthening the monitoring of BK virus and adjusting the immunosuppressive regimen in time are very important. 

Objective To explore the characteristics of perioperative complications in renal transplant recipients with diabetic end-stage renal disease. Methods Sixty-three patients with diabetic end-stage renal disease transplanted in the renal transplantation department of the First Affiliated Hospital of Xi'an Jiaotong University during January 2015 to January 2022 were selected as the experimental group （the diabetic group）， and 61 recipients receiving thekidney on the other side of the same donor were selected as the control group （the non-diabetic group）. Preoperative clinical data and perioperative complications of renal transplantation were compared between the two groups. Statistical analysis was performed using the SPSS 22.0 software. Results The study found significant difference in age， body mass index， time of onset， bladder residual urine， incidence of medium-to-severe coronary artery stenosis and iliac artery lesions （P＜0.05）.In the diabetic group， patients had a higher incidence of delayed graft function， cardiovascular and cerebrovascularcomplications， poor incision healing， and urine leakage， resulting in significantly longer graft function recovery time and hospitalization time （P ＜ 0.05）. Conclusion In the perioperative period of renal transplantation， the incidence of complications of patients with diabetic end-stage renal disease are higher，these complications can affect the recovery oftransplanted kidney function in the short term，but most of the complications are controllable， and a relatively satisfactorytransplantation effect can still be achieved after active treatment. 

 Objective To investigate the influence of donor diabetes on the overall prognosis of patients with acute-chronic liver failure （ACLF） after liver transplantation. Methods A retrospective study was conducted in 839 ACLF patients who received liver transplantation from January 1，2013 to December 31，2013 in Scientific Registry of Transplant Recipients （SRTR） database. Then， the recipients were divided into two groups according to whether they used diabetic donors （93 cases were in DM group，746 cases were in non-DM group）. Donor and recipient baseline characteristics were compared between two groups， and overall survival rates were compared according to different recipient ACLF grades. Univariate and multivariable analysis were further used. Results The overall survival rates were comparable in patients with ACLF1 and ACLF2. However， in patients with ACLF3， the 1，3，5-year overall survival rates were 84.3%，78.3%，72.4% in the non-DM group，it was significantly better than that in the DM group， which were 70.4%，55.6%，51.9%， respectively （P ＝ 0.016）. It showed statistically significant differences in ACLF3. In multivariateanalysis， the age of the recipient （P ＝ 0.001）and the diabetes of the donor （P ＝ 0.007） were independent predictors for post-transplant overall survival for patients with ACLF3. Conclusion In patients with ACLF3， donor diabetes is anindependent predictor for inferior overall survival after liver transplantation. 

Objective To investigate the labeling of mouse pancreatic islets with lentivirus Luciference and to study their fluorescence expression in vitro and in vivo after transplantation in nude mice. Methods The purified and cultured ICR mouse islets were transfected with lentivirus-LUC islet culture medium with a multiplicity of infection of 10 MOI， the islets were then washed and cultured for 24 h. The fluorescence expression of islets labeled with different isletequivalents of LUC in vitro were observed by optical imaging system of small animals within 14 days of culture. In vivofluorescence expression was observed within 30 days after renal subcapsular transplantation in nude mice. Results The activity of islets after LUC gene transfection by this method was （86.7±6.7）%. Using IVIS Lumina LT， LUC-labeled isletsshowed fluorescent expression while cultured in vitro，and the amount of fluorescent expression was related to islet equivalent. In vitro，the fluorescence expression intensity showed a trend of increasing over time within 14 days of culture. After transplanted under the renal capsule of nude mice with LUC-labeled islets， long-term fluorescence expression was seen （＞ 30 days）. However， the intensity of fluorescence expression fluctuated greatly over time.Conclusion In this study，the survival of LUC-labeled islets after transplantation in vivo can be observed in vivo for a long time， which provides a method reference for the follow-up study on the survival and efficacy of islets at the transplant site. 

Objective The addition of insulin therapy to transient expression of the transcription factor（pancreatic and duodenal homeobox gene1，PDX-1） may enable islet regeneration in the pancreas of diabetic mice. Methods Diabetes was induced in C57BL/6J mice（BG ＞ 16.7 mmol/L） by streptozotocin intraperitoneal injection（200 mg/kg）. Gene transfer was then performed by intra-pancreatic injection of an adenoviral vector （1×109 pfu）encoded witheither PDX-1（Ad-PDX-1） or LacZ （Ad-LacZ） control， followed by daily insulin administration. Body weight， blood glucose，and pancreas histology were monitored. Results Our results showed that insulin administration gradually decreased blood glucose level in Ad-Pdx1 group， which became euglycemic （BG ＜ 11.1 mmol/L） and insulin-independent in about two to three weeks. Without insulin， however, no obvious effect was observed. The animals in the Ad-LacZ control group （with or without insulin therapy）remained hyperglycemic throughout the 30 days study course. Histological analysis showed that newly formed islets consisting solely of insulin-producing cells were induced in the pancreas of the mice treated with both insulin and Ad-PDX-1, while no or very few insulin positive cells were observed in control. Conclusion Transient expression of PDX-1 combined with insulin treatment effectively induced the regeneration of functional islet β cells in the pancreas of the diabetic mice， forming new islet and reversing diabetes. This approach may prove to be a novel strategy for the treatment of diabetes.