Objective To investigate the effect of polymorphisms of CYP3A5 gene mutation on the metabolism of tacrolimus in renal transplantation recipients after surgery，and to compare the differences in followup parameters of patients with different metabolic function genotypes after kidney transplantation. Methods The recipients who received allograft kidney transplantation from January 2016 to December 2018 were selectedconsecutively，and the data of each follow-up in the perioperative period of kidney transplantation and the electronicmedical record system after the operation were sorted out，mainly including the general information before the operation，the dose of tacrolimus taken at each follow-up time point（the second week，one month，three months，six months，one year and two years after the operation），the concentration-dose ratio，liver and kidney functionpostoperative complications. CYP3A5 genotype was determined by PCR-SSP method before surgery，and kidney transplant recipients were divided into CYP3A5*1 expression group（AA，AG，28 cases in total）and CYP3A5*1 non-expression group（GG，124 cases in total）according to different genotypes. The differences of clinical indicators between the two groups during the follow-up period were compared and systematically analyzed. Results In this study，a total of 152 recipients of kidney transplantation were included according to the above criteria，including 30 recipients of living donor transplants from relatives and 122 recipients of DCD transplants. There were 52 females（34.21%）with an average age of（43.90±10.81）years and an average weight of（65.51±12.02）kg. Patients were divided into groups according to the difference of CYP3A5 expression，and the preoperative basic data of CYP3A5*1 expression group（AA，AG）and non-expression group（GG）were analyzed. The results showed that there was no statistical difference in the basic demographic clinical characteristics between the two groups. The C0/D value of tacrolimus in the CYP3A5*1 expression group was significantly lower than that in the CYP3A5*1 non-expression group at week 2，month 1，3，6，year 1 and year 2 after renal transplantation（P ＜ 0.01）. Thedaily tacrolimus dose of the CYP3A5*1 expression group was also significantly lower than that of the CYP3A5*1non-expression group at each of the above follow-up time points（P ＜ 0.01）. At the 1st month and 2nd year of follow-up after kidney transplantation，the serum trough concentration of tacrolimus in CYP3A5*1 expression group was significantly lower than that in CYP3A5*1 non-expression group（P ＜ 0.01）. There was no significant difference in blood tacrolimus concentration between the two groups at the follow-up time points of 2 weeks，3 months，6 months and 1 year（P ＞ 0.05）. There were no significant differences in serum creatinine，transaminase，hemoglobin， blood glucose levels，renal biopsy pathological types and postoperative complications between the two groups at each follow-up time point（P ＞ 0.05）. Conclusion Compared with CYP3A5*1 non-expression group，patients in CYP3A5*1 expression group metabolized tacrolimus faster after taking tacrolimus，and higher tacrolimus dose is usually required to reach the target blood concentration range after transplantation. The differences of CYP3A5 gene polymorphism among different renal transplant recipients have no significant negative effects on postoperative liver and kidney function，blood glucose level，graft rejection，graft survival and adverse events. 

Objective To study the safety and efficacy of retroperitoneal laparoscopic living donor nephrectomy after freeing subcostal nerve. Methods The clinical data of 126 donors who underwent retroperitoneoscopic living donor nephrectomy in the department of urology，the First Affiliated Hospital of Anhui Medical University from January 2016 to January 2019 were retrospectively analyzed. The donors were divided into two groups depending on whether the subcostal nerve was freed during donor kidneyharvesting，there were 74 donors in the traditional surgery group and 52 donors in the modified surgery group with freeing subcostal nerve. The donor’length of incision，surgery time，intraoperative blood loss，the length of hospitalization，kidney warm ischemia time and visual analogue scale（VAS）at 12 h，24 h and 48 h after surgery were compared between the two groups. Results All patients（n ＝ 126）finished thenephrectomy successfully，and none was transferred to open surgery. The differences in the length of incision，surgery time，kidney warm ischemia time and intraoperative blood loss between the two groups had no statistical significance（P ＞ 0.05）. The postoperative hospital stay was（6.6 ± 1.7）d in the traditional surgery group and（4.8 ± 1.7）d in the modified surgery group，and the difference between the two groups had statistical significance（P ＜ 0.001）. The VAS scores at 12 h，24 h and 48 h after operation in the modified operation group were significantly lower than those in the traditional surgery group，and the differences were statistically significant （P ＜ 0.001）. Conclusion Compared with traditional retroperitoneoscopic surgery，retroperitoneal laparoscopic donor nephrectomy with freeing subcostal nerves is safe and feasible，it can completely preserve the subcostal nerves and shorten the length of hospital stay and short-term postoperative pain.

Objective To study the therapeutic effect of avatrombopag on severe thrombocytopenia（TCP）in patients waiting for liver transplantation. Methods This study was conducted by analyzing the clinical data of67 patients waiting for liver transplantation with severe TCP in the First Affiliated Hospital of Zhengzhou Universityfrom February 2021 to October 2022. The general information of patients and their platelet count before and afteravatrombopag treatment were collected in this study. Patients were divided into two groups for further analysisaccording to whether recombinant human thrombopoietin（rhTPO）was used at same time. Platelet count no less than 50×109 /L after treatment of avatrombopag was considered as effective response. Results The platelet count of67 patients waiting for liver transplantation with severe TCP was significantly elevated after using avatrombopag（P＝ 0.001）. Moreover，the platelet counts of 89.55%（60/67）patients were higher than 50×109 /L and there was no significant difference in the effective rate between different thrombocytopenia groups（P ＝ 0.373）. Furtheranalysis showed that combined therapy group（avatrombopag and rhTPO）acquired significant higher platelet count than monotherapy group（P ＝ 0.002）with similar basal count level before treatment（P＝ 0.064）. Furthermore，the percentage of patients whose platelet counts were more than 50×109 /L had no significant difference（P ＝ 0.228）between avatrombopag group 85.00%（34/40）and combined group 96.30%（26/27）. Conclusion Avatrombopag could increase the platelet level in severe TCP patients waiting for liver transplantation. Avatrombopag combined with rhTPO may have better therapeutic effect. 

Objective To analyze and compare the clinical efficacy of renal transplantation between extendcriteria donors（ECD）and standard criteria donors（SCD）of the donation after citizen death. Methods Theclinical data of 90 recipients who received cadaveric kidney transplantation in the First Affiliated Hospital of the Air Force Military Medical University from February 2014 to February 2022 and were regularly followed up in the centerand the Urology and Kidney Hospital of Xi'an People's Hospital were retrospectively analyzed. The recipients weredivided into 31 ECD patients and 59 SCD patients. All donor kidneys were routinely preserved by simple hypothermia conditions. All recipients were induced by antibodies，and were routinely treated with triple immunosuppressivetherapy（mycophenolate mofetil capsule/mycophenolate sodium enteric-coated tablets，tacrolimus/cyclosporine， methylprednisolone）. The serum creatinine（Scr），complications and recipient/renal survival rate of the two groups of recipients at 1 month，3 months，6 months，1 year，2 years，3 years and 5 years after renal transplantation were compared and statistically analyzed. Results The Scr level in ECD group at 1 month，3 months，6 months，1 year，2 years，3 years and5 years after operation was significantly higher than that in SCD group（P ＜ 0.05）. In ECD group and SCD group，the incidence of AR was 12.9%（4/31）and 18.6%（11/59），the incidence of DGF was 22.6%（7/31）and 16.9%（10/59），the incidence of lung infection was 12.9%（4/31）and 6.8%（4/59），the incidence of other infections was 25.8%（8/31）and 15.3%（9/59），the incidence of persistent proteinuria was 22.6% （7/31）and 15.3（9/59），and the incidence of other complications was 19.4%（6/31）and 10.2%（6/59）. There was no significant difference between ECD group and SCD group（P ＞ 0.05）. In ECD group，the annual recipient/renal survival rate in 1，3 and 5 years was 93.5/90.3，90.3/83.9，87.1/77.4，respectively，while in SCD group，it was 91.5/93.2，89.8/91.5，88.1/89.8，respectively. There was no significant difference between the two groups（P＞0.05）.Conclusion Compared with SCD，ECD donor kidney transplantation can achieve a certain clinical effect and expand the source of donor kidney，but the long-term clinical effect，especially the renal function，is still slightly worse than SCD. It is necessary to further strengthen the effective function protection and perioperative management of organs to be obtained from ECD. 

Objective To summarize cytomegalovirus（CMV）infection in organ donation and kidneytransplantation after the death of citizens，and to analyze of the effectiveness and safety of prevention and preemptive treatment. Methods Among the 243 patients who received the donation after citizen’s death（DD）allogeneic kidney transplantation for the first time in our hospital，90 patients who met the research criteria were selected，according to different CMV viral loads，they were divided into CMV preventive treatment group （group A ：40 cases），CMV infection preemptive treatment group（group B ：34 cases），and negative control group（Group C ：16 cases）with no evidence of CMV infection，the characteristics of CMV infection，the correlation with Tac trough concentration（C0）and the consistence between CMV low matrix phosphorylation protein 65 （pp65） antigenemia and CMV-DNA were observed. The safety and effectiveness of preventivetreatment with low-dose valganciclovir（450 mg/d or 450 mg/2 d）and preemptive treatment with standard dose ganciclovir〔8 ～ 10 mg/（kg·d）〕were also analyzed. Results The total incidence of CMV infection after DD renal transplantation was 82.22% （74/90）， and the incidence of CMV infection within three months after transplantation was 90%（36/40）in group A and 94.11%（32/34）in group B（χ2 ＝ 0.0481， P＞0.05），the time of CMV infection was（65.62 ±45.74）d in patients induced by Baliximab and（33.06 ± 20.11）d in rATG group（t ＝ 2.9922，P ＜ 0.01），there was no correlation between Tac C0 and CMV infection（F ＝ 0.2 879，P ＞ 0.05）. The positive coincidence rate between CMV-PP65 antigenemia and CMV-DNA was 96.4%，and the total coincidence rate was 65.5%；the absolute values of CD8+ T cells（Ts/Tc）and NK cells in CMV-pp65 antigenemiapositive samples were lower than those in pp65 negative samples（P ＜ 0.05）.There was no significant difference in the effectiveness，adverse reactions and acute rejection（AR）between low-dose valganciclovir and standard dose ganciclovir for prevention and preemptive treatment after DD renal transplantation（P ＞ 0.05）. Conclusion Low dose valganciclovir and standard dose ganciclovir are safe and effective in the prevention and preemptive treatment ofDD renal transplantation. With the active monitoring of postoperative CMV infection，the absolute values of CMVpp65，CD8+ T cells（TS / TC）and NK cells can help diagnose CMV infection more timely and accurately. 

Objective A survey was conducted to get some knowledge about the health related quality of life among the population of living donors of liver transplantation. And comparing them with healthypopulation. Methods Cross-sectional survey design was adopted. The questionnaire was developed based onthe European quality of life five-dimension questionaire（EQ-5D-5L），and the data were collected and statistically analyzed. The specific methods were the rank sum test（Kruskal-Wallis H）of multiple independent samples and the non-parametric test（Mann-Whitney U rank sum test）of two independent samples. Results There were totally 77 cases of donors recruited in this study，of which the proportion of males was 23.4%，while the one of female was76.6%. The average height was（161.9±9.0）cm. There were problems on the dimension of anxiety/depression， and the percentage was 68.8%. Followed by pain/discomfort，with the percentage of 32.5. The least problem was the dimension of self-care，only showing a proportion of 1.3%. The average score of VAS was 77.97±17.78. The variable of marriage showed significant difference on the dimension of self-care. The variable of gender showed significant difference on the dimension of anxiety/depression. With the comparison between the donors and healthy population， the dimension of pain/discomfort，anxiety/depression and VAS have statistical difference. Conclusion The healthrelated QOL of donors was relatively well. The gender and marriage were the impact factors. Comparing to the healthypopulation，some dimension of QOL has big space to improve.