ObjectiveTo analyze the independent risk factors for achieving a textbook outcome （TO） inliver transplant （LT） surgery for patients with hepatocellular carcinoma. MethodsRetrospective analysis of clinical diagnosis and treatment data of patients with HCC who underwent LT in the Liver Transplantation Department of Sun Yatsen Memorial Hospital， Sun Yat-sen University from June 2019 to December 2022 was performed. A total of 134 patients were included， including 124 males and 10 females， with a median age of 54（47 ～ 60） years. According to whether TO was achieved， they were divided into the TO group （n ＝ 41） and the non-TO group （n＝ 93）. Univariate and multivariatelogistic regression analyses were used to identify independent factors affecting TO. ResultsApproximately one-third（30.6%） of hepatocellular carcinoma patients achieved tumor obliteration （TO） after liver transplantation （LT）. Multivariate analysis showed that preoperative bilirubin ≥ 54.1 mmol/L （OR ＝ 9.75，95% CI ＝ 2.01 ～ 47.28，P ＝ 0.005） and biliary stasis in donor liver （OR ＝ 2.93，95% CI ＝ 1.21 ～ 7.13，P ＝ 0.018） were independent risk factors for achieving TO. Further analysis revealed no statistical difference in long-term survival rates between the TO group and non-TO group （χ2 ＝ 1.127，P ＝ 0.288）. ConclusionPreoperative high serum bilirubin and cholestasis in the donor liver areindependent risk factors for achieving TO after liver transplantation in patients with hepatocellular carcinoma. Currently， no differences have been found in the long-term survival rates between different groups. As a comprehensive indicator of shortterm prognosis，TO can be used to compare the quality of nursing among different centers after liver transplantation.

ObjectiveTo investigate the potential relationship between fibrin degradation product （FDP）levels and the development of biliary complications （BC） after liver transplantation， and to summarize the riskfactors associated with the development of BC. Methods A retrospective cohort study was conducted in patients undergoing liver transplantation from January 2015 to July 2022 in the Southwest Hospital， Army Medical University and Sichuan Provincial People's Hospital. Demographic data， clinical indicators， and prognostic follow-up informationof patients were analyzed. Overlap weighting （OW） was used to reduce bias. Receiver operating characteristic （ROC） curves were applied to define the cutoff value of FDP. The value divided patients into high- and low-FDP groups. Logistic regression identified risk factors. ResultsA total number of 491 patients were enrolled， and 79（16.1%） suffered from BC. Multivariable logistic regression revealed that FDP ＞ 10.65 mg/L and MELD score ＞ 15 were associated with BCs after OW. ConclusionHigh FDP had significant effect on the risk of BC occurrence and FDP ＞ 10.65 mg/L was an independent risk factor for BC. 

ObjectiveTo assess the safety and efficacy of direct antiviral drugs （DAAs） inhepatitis C virus （HCV） negative recipients undergoing kidney transplantation from HCV IgG （+） / HCVinfected renal allografts. MethodsA total number of 12 patients were enrolled in the Institute of OrganTransplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from 2018to 2023， including 10 patients who were preemptively started DAAs regimen immediately after transplantation， and 2 patients who were therapeutically given DAAs regimen after abnormal liver function anddetectable viral load. All patients had 12-week oral antiviral regimen of sofosbuvir/velpatasvir （SOF/VEL）. Blood transaminase， serum creatinine， eGFR，drug concentration and HCV viral load were regularly reviewed to evaluate the efficacy and safety of DAAs. ResultsOne case of treatment failure occurred after the completion ofSOF/VEL therapy in 10 preemptively-treated patients， and the genotype was detected as 3b. The other 9 recipients achieved sustained virological response （SVR）12 weeks after the end of SOF/VEL treatment. After altering the antiviral regimen twice in succession， the patients who failed in the initial treatment ultimately achieved SVR12 with a DAAs combination containing ribavirin （RIB）. Abnormal liver function and high HCV viral load were detected in 2 therapeutically treated patients one month after transplantation， the patients had normalized transaminase once SOF/VEL combination was started and achieved SVR12 eventually. The patients who failed to achieve SVR12 showed persistent abnormal bilirubin during the treatment of DAAs containing ribavirin. The serum creatinine and drug concentration of all patients were stable during the follow-up period. ConclusionIt is safe and effective for HCV uninfected recipients to receive HCV-positive kidney grafts with DAAs prophylactic or therapeutic therapy. For patients infected with subtype 3b HCV and failed in the initial treatment of pan-genotypic DAAs regime， a combination of SOF/VEL/RIB is recommended. 

肾移植 ； 肺部感染 ； 宏基因二代测序 ； 治疗经验

ObjectiveA retrospective analysis of clinical data was performed to uncover riskfactors for obstructive sleep apnea （OSA） in patients after lung transplantation. MethodsFrom January 1， 2020 to January 1，2022，the clinical data of 27 patients with OSA as well as 28 patients without OSA after lung transplantation in Wuxi People's Hospital were collected. Polysomnography （PSG） was performed in clinically stable patients ＞ 1 month after transplantation，according to the apnea-hypopnea index （AHI）＝ 5 events/h，ithe patients were divided into OSA group （AHI ≥ 5 events/h） and non-OSA group （AHI ＜ 5 events/h）. The differences in observation indicators between the two groups were analyzed， and univariate and multivariate logisit regression analysis was performed. ResultsThe body mass index（BMI）、neck circumference and ratio of pre-transplant COPD/IPFto other lung diseases of the OSA group were significantly higher than those in the non-OSA group. Univariate logisticregression analysis showed BMI （OR ＝ 1.263，95% CI ＝ 1.051 ～ 1.517，P ＝ 0.013）， neck circumference （OR ＝1.180，95% CI ＝ 1.014 ～ 1.374，P ＝ 0.032）， and the ratio of pre-transplant COPD/IPF to other lung diseases （OR ＝8.088，95% CI ＝ 1.588 ～ 41.189，P ＝ 0.012） as risk factors. Multivariate logistic regression analysis showed that theratio of pre-transplant COPD/IPF to other lung diseases （OR ＝ 5.784，95% CI ＝ 1.047 ～ 31.963，P ＝ 0.044） was anindependent risk factor. ConclusionBMI， neck circumference， and pre-transplant COPD were risk factors for OSA in post-transplant patients， and pre-transplant COPD was an independent risk factor for OSA. 

ObjectiveTo compare the efficacy of combining haploidentical donor blood and cord bloodstem cell transplantation （Haplo-cord HSCT） with haploidentical stem cell transplantation （Haplo-HSCT） inthe treatment of severe aplastic anemia （SAA） in children. MethodsA retrospective analysis was performed on38 cases of SAA who underwent haplo-HSCT in Department of Hematology and Oncology of Shanghai Children’s Hospitalfrom May 2017 to February 2023. A total number of 21 children with SAA received Haplo-Cord HSCT， while 17 childrenreceived Haplo-SCT. The regimen used myeloablative conditioning （fludarabine， busulfan， cyclophosphamide and rabbit anti-thymocyte globulin）. ResultsNo primary graft failure （PGF） occurred in any of the 21 patients in Haplocord cohort， and one patient developed PGF in the Haplo cohort. Two patients in Haplo-cord cohort and one patient inHaplo cohort developed Secondary graft failure，respectively. The median time for engraftment for granulocytes in the Haplo core group and Haplo group were 12（10，19） d and 11（10，16） d, respectively（P ＝ 0.630）. While the median time for platelet implantation in these groups were 16（12，32） and 16（13，24）d, respectively（P ＝ 0.461）. Patients who underwent an Haplo-cord HSCT had a lower cumulative incidence of Grade Ⅱ to Ⅳ aGVHD compared with the Haplo HSCT cohort 〔（23.8±9.3）% vs. 25±10.8）%，P ＝ 0.770）〕， they also had lower cumulative incidence of Grade Ⅲ to Ⅳ aGVHD comparedto the Haplo cohort 〔（9.5±6.4）% vs.（18.7±9.8）%，P ＝ 0.374）〕. The cumulative incidence of chronic GVHD was （14.3±7.6）% in Haplo-cord cohort and was（33±12.2）% in Haplo cohort（P ＝ 0.226）. The 3-year overall， failure-free， and GVHD failure-free （GFFS） survival rates in Haplo-cord cohort and Haplo cohort were 〔（95.2±4.6）% vs.（85.6±9.7）%， P ＝ 0.405）〕，〔（83.5±8.9）% vs.（82.4±9.2）%，P ＝ 0.642）〕 and 〔（81±8.6）% vs.（52.9±12.1）%，P ＝ 0.046）〕，respectively. We found that cord blood with a high degree of HLA matching and high CD34+ cell counts achieved high GFFS. PCR analyses of short tandem repeats （STR） showed persistent and sustained full haplo donor myeloid chimaerism， withoutany evidence of umbilical cord blood engraftment. We found that Haplo-cord HSCT in children with SAA achieved higher GFFS. Conclusion Haplo-HSCT is an effective treatment for children with SAA， with a high engraftment rate. The coinfusion of an UCB may improve survival of Haplo-HSCT in SAA patients. 

ObjectiveThis survey was conducted to get some knowledge about the growth status and intestinal microecology of pediatric liver transplantation patients. MethodsA total of 30 children’s stool sample were collected, the samples were analyzed by gene sequencing. Meanwhile, the clinical data and personal information were included into analysis. ResultsThe average month age was （6.1±1.5）m. The average height, weight and body mass index （BMI） were （65.8±3.7）cm, （6.7±1.1）kg and 15.1±1.6, respectively. As for the gender, 10 cases were men while 20 cases were women. The most common blood type was A which accounted for 33.3%, followed by B（23.3%）, O（30.0%） and AB（13.4%）. There were statistical differences between normal and abnormal groups in weight, BMI, weight Z score and BMI Z score on the operation day. However, 18 months after operation, there were statistical differences betweentwo groups in height and weight. ConclusionLiver transplantation can improve the growth of biliary atresia patients, and intestinal flora correlates to growth. 

ObjectiveTo observe the effects of metronomic capecitabine （CAP） on immune cells and rejection in acute liver transplant rejection in rats， and to explore its immunosuppressive effect. Methods A rat liver transplantation acute rejection model was established and randomly divided into a control group （CON group）， a metronomic capecitabine group （CAP group）， and a metronomic capecitabine+tacrolimus（Tac） group （CAP+Tac group）. Venous blood was collected on the 1st，3rd， and 7th day after liver transplantation， and enzyme-linked immunosorbent assay （ELISA） was used to detect IL-2 and IFN-γ concentrations， the trends of changes and correlations of IL-2 and IFN-γ between groups. Results Compare to the CON group，the concentration of serum IL-2 and IFN- γ gradually decreased in the CAP and CAP+Tac groups on the 1st，3rd，and 7th day after transplantation， and there was a statistically significant difference between the these two groups and the CON group （P ＜ 0.05）. ConclusionThe metronomic capecitabine can reduce peripheral blood IL-2 and IFN-γ during acute rejection of liver transplantation in rats， it has potential immunosuppressive effects.