Objective To establish an ex situ machine perfusion（MP）system for long-term liverperfusion using normothermic machine perfusion（NMP）technology. Methods A porcine liver was connectedto the Life-X100 perfusion system for normothermic machine perfusion. Perfusion parameters and perfusate blood-gas analysis results were continuously monitored during the perfusion process to assess the ex situ liverfunction. Results The porcine liver was successfully perfused ex situ for 138 hours，with stable perfusionparameters and well-maintained liver function. Conclusion We have preliminarily established an ex situ longterm liver perfusion system. This system can be used for the ex situ maintenance of human livers in the future and can serve as a basis for various exploratory studies to advance medical development in our country. 

Objective To develop a human liver splitting model with disease using normothermicmachine perfusion. Methods A liver from a liver transplant patient with acute-on-chronic liver failure and hepatitis B cirrhosis was split into left and right lobes，and the hepatic artery and portal vein of each half were respectively connected to two separate perfusion system for normothermic machine perfusion. Pressure and flow were continuously monitored during perfusion，and perfusate samples were collected for blood-gas analysis toassess the function of the diseased liver. Results Both lobes of the graft were successfully perfused in vitro for 16 h. Throughout this period，the pressure，flow，and other parameters of perfusion remained stable. The blood-gas analysis results of the perfusate were maintained within the physiological range. Conclusion We have successfully established a splitting perfusion model of diseased liver after liver transplantation that mimics human physiological and pathological conditions. This model allows for the detailed study of liver function under conditions that closelyapproximate human physiology. 

Objective The purpose of this study is to evaluate the potential effect of ischemia-free liver transplantation（IFLT）technology in reducing the recurrence of hepatocellular carcinoma（HCC）after liver transplantation，and to compare it with the outcomes of conventional liver transplantation（CLT）. Methods We conducted a retrospective cohort study，including 208 HBV-HCC patients who underwent liver transplantation at the First Affiliated Hospital of Sun Yat-sen University from January 1，2018，to May 31，2021. Among them，22 cases received IFLT，and the remaining 186 patients received CLT. Patients were divided into IFLT and CLT groups based on the type of surgery they received，and the tumor recurrence rate，early postoperative liver function indicators，incidence of complications，and other perioperative data were compared between the two groups. The primary endpoint was tumor recurrence，and secondary endpoints included early allograft dysfunction（EAD），andserum alanine aminotransferase（ALT）and aspartate aminotransferase（AST）levels. Results The recurrence-free survival period in the IFLT group was significantly higher than that in the CLT group（P ＝ 0.037）. The incidence of EAD in the IFLT group（4.5%）was significantly lower than that in the CLT group（26.3%，P ＝ 0.046）. The peak serum ALT and AST levels，as well as the peak total bilirubin levels，were all significantly lower in the IFLT group compared to the CLT group within seven days postoperatively. Conclusion IFLT technology helps avoid ischemiareperfusion injury（IRI）by maintaining the blood and oxygen supply to the liver graft，which reduces the risk of hepatocellular carcinoma（HCC）recurrence and improves the quality of the donor liver. IFLT is expected to become an effective strategy for reducing the recurrence of HCC after liver transplantation and improving patients' long-term prognosis. 

Objective To investigate the clinical features of elderly patients undergoing ischemia-free liver transplantation（IFLT）and to propose nursing strategies. Methods The clinical data of 107 patients with end-stage liver disease who underwent IFLT at the Organ Transplantation Center of the First Affiliated Hospital of Sun Yatsen University from July 2017 to December 2022 were retrospectively analyzed. Thirty patients aged over 60 years old were enrolled in the elderly group and 77 patients less than 60 years old were enrolled in the control group. Results Thirty elderly patients recovered smoothly after operation. No complications such as postoperative incomplete ileus，hemorrhage and biliary complications occurred. The incidence of pulmonary infection in the elderly group was significantly higher than those in the control group（P ＜ 0.05）. There was no significant difference in the postoperative hospital stay and the control group（P ＞ 0.05）. Conclusion There are certain differences between elderly non ischemic liver transplant recipients and young recipients in the clinical rehabilitation process，especially in terms of pulmonary infection. Preoperative deep breathing，effective coughing，and respiratory function exercise，postoperative enhanced early mobilization，close observation of the condition，use of antibiotics according to medical advice，guidance on correct diet，and strengthening nutrition can reduce the incidence of pulmonary infection after liver transplantation 

Objective Based on the concept of organ medicine and the application of normothermic machine perfusion technology，a new in vitro and in vivo multi-organ laparoscopic system was created. Methods Smagister consists of a normothermic machine perfusion platform，porcine abdominal organs（liver，gallbladder，pancreas， stomach，intestine，kidney，uterus，bladder，etc.），a laparoscopic light source，a laparoscopic lens，an ultrasonic scalpel，laparoscopic surgical instruments，a high-definition monitor，and a software system. The logbook recordedthe results of blood gas analysis per hour and the number of intestinal peristalsis per hour. Organ population viability was subjectively assessed hourly by means of questionnaires. Three types of Laparoscopic surgery are performed on the Smagister，including laparoscopic cholecystectomy（LC），laparoscopic enterotomy closure（LEC）， laparoscopic liver resection（LLR），to demonstrate the specific procedures of each procedure. Experts in related fields were invited to compare the feasibility of completing the operation and the demonstration of complications with the actual operation. Results The mean arterial pressure of the perfusion machine was maintained at60 mmHg（1 mmHg ＝ 0.133 kPa），blood flow at approximately 1 000 ml/min，and organ temperature between 36.5 ～ 37.4℃ throughout the procedure. The intestinal peristalsis could be clearly seen during the whole perfusion process，with an average peristalsis frequency of 2.2 times /min，which was maintained until the end of the experiment. During the laparoscopic operation，clear bile secretion could be seen when the porta hepatis were separated and the bile duct was ligated. In addition，when the blood vessel was injured during liver resection，the blood vessel rupture and blood outflow can be seen. Experts evaluated that the organ activity was good during the whole laparoscopic operation，the anatomical structure of the organ could be clearly displayed，and the tactile feedback of the operation was very real. Conclusion Smagister combines a live animal model with an ex vivo simulation，pooling the advantages of both modalities and expanding the training field to provide high-quality laparoscopic training for both novice and veteran surgeons. 

Objective To establish a liver transplantation anhepatic model in Bama miniature pigswith high repeatability and stability. Methods Five Bama miniature pigs were selected to construct a liver transplantation model in the anhepatic stage. In order to avoid intestinal congestion and circulatory failure in the anhepatic stage，a veno-venous bypass model was adopted to maintain stable blood pressure in the anhepatic stage， and to enhance intraoperative anesthesia and fluid management. The changes of hemodynamic indexes of intestinal injury，kidney injury and internal environment were observed and recorded at 6 time points ：30，60，90 min after VVB，before blood vessel occlusion and 30 min after vessel opening. Results The established veno-venous fluid transfer model of small pig liver transplantation in the anhepatic stage had adequate venous drainage. The

main results showed that 5 Bama small pigs were all alive，and the intestinal tube color was rosy and the peristalsis was normal，and the urine volume was normal. The operation time was（160±8）min，the blood loss was（158±32）ml，and the fluid rehydration was（1 760±251）ml. Compared with before vascular occlusion，the heart rate of the animals was significantly increased during vascular occlusion，the MAP was significantly decreased to（44±15）mmHg（1 mmHg ＝ 0.133 kPa），the blood pH was decreased，and the lactic acid was increased，heart rate slowed，and blood pH did not change significantly in lactic acid throughout the experiment，the experimentalanimals did not change significantly in electrolyte，while creatinine and intestinal fatty acid binding protein slowly increased. Conclusion The established Bama small porcine liver transplantation model is stable and safe，which can provide an effective animal model for further clinical trials such as validation of veno-venous transfer device. 

Objective To explore the early warning model of acute graft-versus-host disease（aGVHD）after haplotype hematopoietic stem cell transplantation in adult myelodysplastic syndrome（MDS）. Methods The clinical data of 50 adult MDS patients who received haplotype hematopoietic stem cell transplantation at the Second Affiliated Hospital of Air Force Medical University from January 2021 to January 2023 were included. Patients with acute graft-versus-host disease after treatment were included in the occurrence group，and patients withoutacute graft-versus-host disease were included in the non-occurrence group. The clinical data of patients were collected and analyzed，the influencing factors of acute graft-versus-host disease after haplotype hematopoietic stem cell transplantation were determined by Logistic regression analysis，and the nomogram early warning model was constructed by using the determined independent influencing factors，and the effectiveness of the nomogramprediction model for acute graft-versus-host disease after haplotype hematopoietic stem cell transplantation wasevaluated. Results Fifty adult MDS patients received haplotype hematopoietic stem cell transplantation in our hospital. The incidence of patients with acute graft-versus-host disease was 30%，while the proportion of patientswithout acute graft-versus-host disease was 70%. Logistic regression analysis showed that donor sex，race and C- reactive protein were the risk factors for acute graft-versus-host disease（OR ＞ 1，P ＜ 0.05），while uric acid was the protective factor for acute graft-versus-host disease（OR ＜ 1，P ＜ 0.05）in adult MDS patients after haplotype hematopoietic stem cell transplantation. ROC curve was drawn with certain independent influencing factors，and the results showed that the AUC values of donor's sex，race，uric acid and C- reactive protein were all above 0.60，which indicated that the above indexes provided value for early warning of acute graft-versus-host disease afterhaplotype hematopoietic stem cell transplantation. Using the above independent influencing factors，a nomogram earlywarning model was constructed，and the value obtained by adding the scores of risk factors was the probability of acute graft-versus-host disease after haplotype hematopoietic stem cell transplantation. The verification results showed that the C-index value of the calibration curve was 0.846，which indicated that the nomogram prediction model had good prediction energy efficiency. Conclusion The nomogram constructed by influencing factors of acute graft-versus-host disease after haplotype hematopoietic stem cell transplantation can predict the incidence of this disease，specific treatment and nursing should be carried out according to gender，race and C-reactive protein to reduce the risk of acute graft-versus-host disease. 

Objective To understand the status and hot spots of the research on the health management of kidney transplantation recipients in China，to discuss the research deficiencies and development trends，andto provide reference for the development of this field. Methods The relevant literatures were retrieved from CNKI，Wanfang，Weipu and China Biomedical database on August 8，2023，and visualized with CiteSpace and VOSviewer. Results A total of 678 Chinese literatures were retrieved，the number of which showed anincreasing trend. The published journals were concentrated，and the cooperation between authors and institutions was limited and regional. Research hotspots included medication compliance，self-management，quality of life，social support，the frontier areas include telemedicine，life-cycle follow-up management，and evidence-based nursing. Conclusion The study on the health management of kidney transplant recipients has gradually changed from passive health education to active health promotion，but the research force still needs to be strengthened. It is recommended to apply telemedicine and evidence-based concepts，improve the follow-up management system，andstrengthen the follow-up management of the whole life cycle. 

Objective To establish a digital health management system for the full life cycle of organ transplant recipients （SWOR） and to summarize the trial experience with SWOR. Methods SWOR was built using a smartphone app and a WeChat mini-program. It consists of modules for medical procedures，daily health metrics，test results，imaging reports，medication plans，and doctor-patient communication. Recipients input relevant information through the patient interface，while the follow-up team uses the physician interface to randomly select recipients and review their data，including time-series data curves generated from these modules. Results Between March 2019 and May 2024，1 730 organ transplant recipients participated in the trial， comprising 1 235 males and 477 females，with 1 648 adult and 82 pediatric recipients. The trial included recipients of all organ transplant types ：liver（57.5%），kidney（28.2%），lung（6.13%），heart（2.83%），pancreas（0.17%），small intestine（0.06%），and combined transplants（5.14%）. Randomly extracted data from the SWOR system showedthat the module contents and follow-up indicators were effectively displayed，and the data was clearly represented intime-series curves. Conclusion This study provides preliminary evidence that SWOR offers a practical digital tool for managing the health of organ transplant recipients. 

Objective To summarize the experience in the treatment of antibody mediated rejection（AMR）after kidney transplantation. Methods A retrospective analysis was conducted on kidney transplant recipients who was diagnosed as AMR by biopsy in the Third Medical Center of the General Hospital of the People's Liberation Army from 2018 to 2021. Regular follow-up and prognosis were analyzed after treatment. The survival time of the graft between different time of rejection after transplantation，pathological type，DSA type，and number of kidney transplants were compared，and factors that may affect prognosis were preliminarily screened. Results The results showed that 14 recipients were diagnosed with AMR. After combination therapy of plasma exchange，lymphocyte depleting antibody and immunoglobulin treatment，the overall 1-year graft survival rate was 78.6%，and the 5-year survival rate was 43%. Within 6 months after treatment，3 cases with infection required hospitalization，including 1 case of cutaneous herpes zoster infection，1 case of urinary tract infection，and 1 case of diarrhea. There were nolife-threatening or graft loss case directly related to infection. Conclusion A combination treatment based on plasma exchange can achieve some effects in the treatment of antibody mediated rejection after kidney transplantation. Further research is needed on the optimization of protocols for different types of rejection. 

Objective To analyze the difference of immunosuppressant regimen adjustment between renal transplant recipients with pathological results of rejection and BK polyomavirus nephropathy. Methods Thirty two cases were selected from the Kidney Transplantation Department of the First Affiliated Hospital of Xi'an Jiaotong University from June 2019 to May 2024，who tested positive for BK in blood and had subsequent pathological results of rejection and BK virus nephropathy in transplanted kidneys. Based on the pathological results of transplantedkidneys，they were divided into a rejection group（21 cases）and a BK virus nephropathy group（11 cases）. Theclinical data such as the discovery time and value of plasma BK，adjustment of immunosuppressant regimen， immunosuppressant blood concentration，pathological diagnosis time and results，BK negative time，and transplanted kidney function status were collected and analyzed. Results The dosage of mizoribine in the rejection group（median was 100 mg/d）was significantly lower than that in the BK polyomavirus nephropathy group（median was 150 mg/d）.The time from plasma BK detected to pathological diagnosis established was significantly longer than that in the BKpolyomavirus nephropathy group（P ＜ 0.05）. There was no significant difference in loss of transplanted kidney （P ＞ 0.05）. Conclusion For kidney transplant recipients with persistently plasma BK，the incidence of rejection reactions is higher after adjusting the immunosuppressive regimen. Rejection caused by insufficient immunosuppressive dosage and delayed pathological diagnosis should be avoided to reduce the occurrence of transplanted kidney damage.