Objective To analyze the systemic infection of organ donation donors， and to provide more clinical evidence for the control of donor infection. Methods 76 cases of organ donation were completed in theDepartment of Critical Care Medicine of the Third Affiliated Hospital of PLA Military Medical University （Daping Hospital）from January 2017 to December 2021，including 32 cases of donation after brain death （DBD） and 44 cases of donation after circulatory death （DCD）. Clinical data of donor age， sex， cause of disease， infection site， sputum culture and drug sensitivity test results， central venous catheter blood culture and drug sensitivity test results， peripheral blood culture and drug sensitivity test results， urine culture and drug sensitivity test results were collected. Results Lung infection was the most common site in 76 organ donors. Gram negative bacteria accounted for 30.3%， gram positive cocci accounted for 14.4% ，fungi accounted for 5.3%，and 6 strains of multidrug-resistant bacteria accounted for 15.8% of the total cases. Conclusion Infection is not a contraindicated for organ donation. When the donor is found to have infection or suspected infection， anti-infective treatment should be initiated as soon as possible. Samples from various sites should be actively collected for examination to screen the infected sites and determine the pathogenic bacteria，and to guide timely target anti-infective treatment. 

Objective To determine whether microbial contamination of preservation solution （PS） is associated with donor derived infection （DDI）. Methods The clinical data of 624 renal transplant recipients admitted at the Organ Transplantation Center of the First Affiliated Hospital of Naval Medical University from March 2016 to September 2022 were retrospectively analyzed. Recipients were divided into positive group and negative groupaccording to the culture results of PS. The distribution of pathogenic bacteria in organ PS was analyzed and the infection events after transplantation between two groups were compared. Results Among 624 organ PS，349 cases（55.93 %）were PS culture positive， single pathogen was found in 230（65.90%）cases，and 119（34.10%） cases were found to have two kinds of pathogens. A total of 497 strains of pathogens were isolated， and the top three were coagulase negativestaphylococcus （n ＝ 83，16.70%）， Enterobacter species （n ＝ 61，12.27%） and Klebsiela pneumoniae（n ＝ 53，10.66%）. Infection rate after transplant in positive group was higher than that in negative group 〔26.36%（92/349）vs. 17.82% （49/275）〕. Statistical significance was noted between two groups（P ＜ 0.05）. A total number of 45 recipients were infected with probable donor-derived infections（p-DDIs），and 25（55.56%） recipients of which were infected with multidrug-resistant gram-negative bacteria （MDR GNB）. MDR GNB may cause severe infection-related events （P ＜ 0.05）. Conclusion Contamination of the PS is common in transplantation，it is the risk factor for postoperative infection of recipients. Organ PS should be cultured routinely. If MDR GNB are positive in PS culture， it is recommended to takespecific and effective antibacterial treatment. 

 Objective To investigate the clinical manifestations， diagnosis and treatment strategies ofpulmonary mycobacterium tuberculosis （MTB） infection after liver transplantation. Methods Clinical data of7 patients who underwent liver transplantation in Shenzhen Third People's Hospital from January 2018 to January 2021 and complicated with postoperative pulmonary MTB infection were collected， their clinical manifestations， imaging features， diagnosis and treatment methods， and treatment outcomes were analyzed. Results The time of MTBinfection after liver transplantation was 2.5 ～ 48 months， with a median time of 12 months， the infection sites were all in the lungs. Among the 7 cases，5 cases had no obvious clinical symptoms at the time of diagnosis （71.4%）， and 3 caseshad imaging findings of typical MTB infection on lung CT （42.9%）. Tuberculosis （TB） specific antigen was detected in 5 cases （71.4%）， MTB culture was positive in 3 cases （sputum，14.3% ； alveolar lavage fluid in 2 cases，28.6%）， and MTB nucleic acid test was positive in 2 cases （28.6%）. The anti-TB treatment strategies of the 7 patients included HRZE regimen in 1 case，1 case had isoniazid monotherapy，1 case had levofloxacin + isoniazid + ethambutol regimen， 1 case had moxifloxacin + linezolid +ethambutol + isoniazid regimen，2 cases had moxifloxacin + linezolid regimen， and1 case received rifapentine + isoniazid regimen. At follow-up from 2 to 19 months，2 patients died more than 3 months after liver transplantation，3 patients were cured of pulmonary MTB infection， and 2 patients were still receiving anti-TB treatment. Conclusion The clinical manifestations of pulmonary MTB infection after liver transplantation are often atypical and difficult to diagnose， the delayed treatment may lead to poor prognosis. Clinicians should fully recognize this disease， screen and treat it as soon as possible.

Objective To investigate the pathogenic microbiological characteristics， clinical characteristics，diagnosis and treatment experience of interstitial pneumonia after renal transplantation. Methods The 109 patientswith interstitial pneumonia after renal transplantation diagnosed in the First Affiliated Hospital of Xi'an Jiaotong University from January 2018 to June 2022 were selected. The clinical characteristics，results of pathogenic microbiology， antiinfection strategies and clinical outcomes were analyzed retrospectively. ResultsPathogenic diagnosis of interstitialpneumonia after renal transplantation was difficult， and mixed infection was the main pathogenesis. The main pathogenswere pneumocystis jirovecii in 26 cases （23.9%）， cytomegalovirus in 22 cases （20.2%）， mycoplasma in 15 cases （13.8%），and klebsiella pneumoniaein 13cases （11.9%）. After comprehensive treatment，97 patients（89.0%） were cured and 12（11.0%） died. ConclusionThe diagnosis of interstitial pneumonia after renal transplantation is based on clinical symptoms and imaging manifestations. Pneumocystis jirovecii and cytomegalovirus are the main pathogens. Dynamicmonitoring， early diagnosis and early preventive full course treatment should be carried out for high-risk patients. In the clinic， the key to the treatment of interstitial pneumonia is to provide oxygen support in time， adjust the immunosuppression scheme， reduce inflammatory factors， timely check the next generation sequencing （NGS），and transform from empirical totargeted effective anti-infection therapy. At the same time， immune function of the body and effective nutritional support are necessary. 

Objective To investigate the colonization of multidrug resistant organisms （MDROs） and the impact of antibiotic therapies on MDROs colonization in patients with cholangitis after Kasai procedure，and to provide scientific evidence for clinical prevention and control measures. Methods Cases with cholangitis after Kasai surgery from January 2021 to June 2022 in Tianjin First Central Hospital were retrospectively collected. The children were divided into case group （colonized） and control group （non-colonized） according to their MDROs colonization status when admitted to pediatric department， and the general conditions， Kasai procedure time， biliary atresia classification， previous cholangitis times and previous use of antibiotics were compared between the two groups. Results A total number of 76 strains of pathogenic bacteria were detected in rectal swabs of 64 children， including 43in the MDROs group and 21 in the non-MDROS group.Klebsiella pneumoniae was the most common bacterium （37 cases，33cases were carbapenemresistant）， followed by Enterococcus faecium（12 cases，1 case was vancomycin resistant） and Escherichia coli（11 cases，4 cases were carbapenem-resistant）. There were no significant differences in general conditions， Kasai operation time， biliary atresia classification， and previous cholangitis times between the two groups. The rate of therapy with carbapenems in MDROs group was higher than that in non-MDROS group （53.5% vs. 33.3%，P ＝ 0.129）. The rate of therapy with broadspectrum antibiotics in MDROs group was higher than that in non-MDROS group （39.5%vs. 19.0%，P ＝ 0.101）. The rate of therapy with more than two antibiotics in MDROs ，group was higher than that in non-MDROS group （51.2% vs. 19.0%，P＝0.014）. ConclusionCombination antimicrobial therapy with two or more drugs may lead to colonization of MDROsresulting in bloodstream infection and biliary tract infection of MDROs due to intestinal bacterial translocation. Therefore，effective prevention and treatment measures should be taken to reduce the incidence of MDROs in children after Kasai. 

Objective To investigate the incidence and influential factors of low level of viremia（LLV） inhepatitis B related liver transplantation（LT） recipients. Methods We retrospectively analyzed the clinical data of 90 recipients who underwent liver transplantation for hepatitis B related end-stage liver disease in the Affiliated Hospital of Qingdao University，49 recipients meeting the inclusion criteria who underwent LT from December 2006 to February 2021 were enrolled. Real-time fluorescent quantitative polymerase chain reaction（RT-qPCR） was used to detect hepatitis B virus （HBV） DNA levels in these recipients. According to HBV DNA load， the recipients were divided into two groups ：LLV group（6 recipients） and complete virological response （CVR） group（43 recipients）. The incidence ofLLV and risk factors of LLV in hepatitis B LT recipients were analyzed. ResultsThere were 6 recipients in LLV group had no recurrence of hepatitis B indicated by routine detection methods， with an incidence of LLV of 12.24%. Among the6 LLV recipients，2 were given nucleoside analogues（NAs）+ hepatitis B immune globulin（HBIG）and 4 were given NAs for prevention of hepatitis B recurrence. Univariate analysis showed that high preoperative HBV DNA load， postoperative tumor recurrence， preoperative tumor stage beyond UCSF criteria and low body mass index （BMI） were the risk factors for LLV in hepatitis B LT recipients （P ＜ 0.05）. Multivariate analysis showed that high preoperative HBV DNA load was an independent risk factors for LLV in hepatitis B LT recipients. Conclusion High preoperative HBV DNAload， postoperative tumor recurrence and preoperative tumor stage beyond UCSF criteria were related to LLV in hepatitis B LT recipients. High preoperative HBV DNA load was an independent risk factors for LLV in hepatitis B LT recipients. Therefore， it is recommended to monitor LLV dynamically by highly sensitive fluorescent quantitative PCR in hepatitis B LT recipients， especially in recipients with late tumor stage and positive HBV DNA before liver transplantation. 

Objective To investigate the experience of the diagnosis and treatment of intestinal perforation after liver transplantation. Methods We retrospectively analyzed the clinical symptoms， laboratory data， imaging data， treatment methods and prognosis of 20 intestinal perforation patients after liver transplantation admitted at Beijing Friendship Hospital from January 2016 to August 2022.Results The incidence of intestinal perforation in liver transplant recipients was 2.8% （18/642） in children and 0.4% （2/487） in adults. Among 18 pediatric recipients， the median time of onset was 13.5（3.0 ～ 404.0） days after liver transplantation. The onset time of the adult recipients was2 to 16 days after liver transplantation. The main clinical manifestations of intestinal perforation were fever， abdominal distension and pain. Some patients developed diarrhea and vomiting. Plain abdominal radiographs in a vertical position were performed in 7 recipients. Subdiaphragmatic and intra-abdominal free air was observed in 4 recipients. Two recipients underwent gastrointestinal angiography， which showed contrast media extravasation. 70% （14/20） of recipients were positive for bacterial culture. 95% （19/20） recipients underwent exploratory laparotomy. Conservative treatment was performedin an adult patient. Two pediatric recipients died of severe infection. Conclusion Intestinal perforation after liver transplantation can lead to the occurrence and aggravation of infection. The use of hormones and immunosuppressants increases the risk of infection. Monitoring the drainage fluid properties and bacterial culture， timely adjusting theanti-infective drug regimen， and performing exploratory laparotomy and intestinal repair are important means to treatintestinal perforation in recipients after transplantation. 

Objective To explore the effect of "picture-type nursing preparation checklist" in reducingpreoperative and intraoperative preparation time for liver transplantation patients. Methods The control group was selected from 60 patients undergoing orthotopic liver transplantation in our hospital from January 2019 to January 2020， and the preoperative preparation time （T1） from the patient's entrance to the start of the operation， the waiting time due to lack of items during the operation （T2） and the preparation time for anhepatic phase（T3） were recorded. The preoperative and intraoperative nursing preparation of liver transplantation was analyzed， and the preoperative and intraoperative "picturetype nursing preparation checklist" was developed， which was used in the observation group of 60 patients undergoing orthotopic liver transplantation from February 2020 to February 2021. The T1， T2 and T3 were recorded， respectively， and statistical analysis was performed between two groups.Results The average T1 in the control group was （60.4±14.2） mins. The longest steps were inadequate preparation for the body position and the inappropriate time and position of the waterproof film. The average T2 was （3.1±0.6） mins. The longest steps were the preparation of shadowless lamphandle， the error of the waterproof film and the incomplete preparation of bipolar electrocoagulation. The average T3 was（17.8±2.1） mins， the core speed-limiting factors were insufficient preparation of drug dispensing timing and dispensingsequence. After adopting the "picture-type nursing preparation checklist"， T1， T2 and T3 of the observation group weresignificantly lower than those of the control group , the time were （45.2±11.3） mins，（1.3±0.3） mins，（13.2±1.2） mins，P ＜ 0.05 respectively. Conclusion The "picture-type nursing preparation checklist" summarized through observationcan improve the work efficiency and nursing quality， and improve the satisfaction of surgeons， which is worth promoting inclinical application.