Severe donor organ shortage has greatly restricted the clinical application of organ transplantation. In China, the utilization of extended criteria donor (ECD) grafts, including donation after cardiac death (DCD) and steatotic grafts have increased year by year, leading to a significantly higher incidence of early allograft dysfunction and other post-transplant complications, as well as a significantly reduced overall survival. To standardize the clinical use of ECD grafts and improve recipients′ outcome, the Liver Transplantation Group, Branch of Organ Transplantation of Chinese Medical Association and Organ Transplantation Physicians of the Chinese Medical Doctor Association have organized experts to summarize and discuss the clinical diagnosis and management of ECD grafts in China by combining the evidence-based medical basis and Chinese clinical practice experience, and by drawing on the relevant domestic and international literature, thereby developed the "Chinese Clinical Practice Guidelines for Extended Criteria Donor Grafts in Liver Transplantation." This guideline addressed a series of recommendations in a scientific and standardized way in terms of donor-recipient status and risk prevention, regarding to DCD grafts, steatotic grafts, small-for-size grafts, elderly donor grafts, and hepatitis B virus-infected grafts. Its purpose is to establish a scientific evaluation and application framework for ECD grafts, balance the risks of organ utilization and survival benefits, and ultimately enhance overall survival and life quality of liver transplant recipients in China.

Autoimmune liver diseases (AILD) constitute a group of special chronic liver disorders caused by immune system dysfunction, including autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis, and overlap syndromes. When the disease progresses to the end stage, liver transplantation becomes an effective treatment. However, these transplant recipients are prone to rejection and disease recurrence. Therefore, the rational application of post-transplant immunosuppressive regimens is particularly crucial for their prognosis. To standardize and optimize the use of immunosuppressive regimens for AILD liver transplant recipients in China and improve their outcomes, the Liver Transplantation Group, Branch of Organ Transplantation of Chinese Medical Association and the Branch of Organ Transplant Physicians of Chinese Medical Doctor Association have organized experts to systematically review and analyze domestic and international evidence-based medicine, combined with clinical practice experience in China, and thereby developed the "Chinese Guidelines for the Application of Immunosuppressive Regimens in Liver Transplant Recipients with Autoimmune Liver Diseases" . These guidelines focus on the indications, prognosis, and immunosuppressive regimens of liver transplantation in AILD and put forward a series of recommendations in a scientific and standardized way, aiming at optimizing the comprehensive management of liver transplant recipients with AILD in China.

To investigate the clinical characteristics and outcomes of post-transplant lymphoproliferative disorder (PTLD) in adult kidney transplant recipients.

A retrospective analysis was conducted on the clinical data of 41 kidney transplant recipients diagnosed with PTLD at the First Affiliated Hospital, Zhejiang University School of Medicine from September 1, 2013, to August 30, 2024. Intergroup comparisons of normally distributed measurement data were performed using group t-test; non-normally distributed measurement data were compared using the Kruskal-Wallis test; categorical data were compared using the chi-square test or the Fisher′s exact test. Kaplan-Meier survival curves were plotted with recipient death as the endpoint, and intergroup survival rates were compared using the log-rank test. Cox proportional hazards model was used to analyze risk factors affecting recipient survival. Cutoff values for continuous variables were determined by receiver operating characteristic curves. A P-value <0.05 was considered statistically significant.

As of November 30, 2024, 14 recipients had died, and 27 were alive. Significant differences were observed between the survival and death groups in the time from transplantation to PTLD diagnosis and the situation of presence of multi-organ involvement (all P <0.05). At the time of PTLD diagnosis, serum creatinine levels were 111.0 (86.0-177.0) μmol/L in the survival group and 142.5 (123.8-171.8) μmol/L in the death group, with a statistically significant difference (H=4.694, P<0.05). The average overall survival period after PTLD diagnosis in the 41 kidney transplant recipients was (83±11) months (1-132 months). Recipients with a time from transplantation to PTLD diagnosis >1 year had a lower survival rate than those with≤1 year (χ²=4.044, P<0.05); recipients with multi-organ involvement had a lower survival rate than those without (χ²=4.368, P<0.05). Multivariate Cox proportional hazards regression analysis showed that a time from transplantation to PTLD diagnosis>1 year (HR=0.108, 95%CI: 0.013-0.992), lactate dehydrogenase>285 U/L (HR=0.171, 95%CI: 0.034-0.874), and multi-organ involvement (HR=0.182, 95%CI: 0.039-0.856) were independent risk factors affecting the survival of PTLD recipients (all P<0.05). There was no significant difference in survival rates between recipients receiving R-sequential therapy and those receiving R-CHOP or other R-containing chemotherapy regimens (χ²=0.001, P>0.05); recipients who achieved lymphoma remission after treatment had a higher survival rate than those who did not (χ²=15.859, P<0.05). Epstein-Barr virus (EBV) and CMV infections were more common in the early-onset PTLD group (all P<0.05).

Adult kidney transplant recipients who diagnosed with PTLD have a poor prognosis, EBV and CMV infections are more common in early-onset PTLD. Time of diagnosis >1 year post-transplantation, multi-organ involvement, and elevated lactate dehydrogenase levels are risk factors for survival.

To systematically evaluate the clinical characteristics and treatment prognosis of patients with moderate-to-severe transplant renal artery stenosis (TRAS), and to explore the risk factors of TRAS after kidney transplantation, providing the basis for early prevention, diagnosis, and treatment.

The clinical data of 16 patients who underwent kidney transplantation in Northern Theater Command General Hospital from January 2022 to July 2024 and were diagnosed with moderate-to-severe TRAS during follow-up were retrospectively analyzed, and recipients who received the other kidney from the same donor were selected as the control group. The basic information, clinical manifestations, laboratory test results, treatment methods, and prognosis of the patients were collected. Independent sample t-test, Mann-Whitney U test, or paired sample t-test were used for comparative analysis of measurement data, while chi-square test or Fisher′s exact probability method were applied to count data. Cox proportional hazards regression was used to analyze risk factors for moderate-to-severe TRAS. The receiver operating characteristic curve (ROC) was used to evaluate the predictive performance of risk factors for TRAS.

The incidence of moderate-to-severe TRAS after kidney transplantation was 4.5%, with a median time of 157 days post-transplantation. At the time of TRAS diagnosis, the TRAS group had significantly higher neutrophil ratio, serum urea nitrogen, creatinine, and cystatin levels, and lower hemoglobin levels compared to the control group (all P<0.05). Univariate analysis showed that the TRAS group had a lower body mass index, higher proportion of re-transplantation, more frequent use of mizoribine, and higher serum lipoprotein a levels compared to the control group, with statistically significant differences (all P<0.05). Cox proportional hazards regression analysis showed that re-transplantation (HR=5.772, 95%CI: 1.227-26.684, P<0.05) and high lipoprotein a levels (HR=1.008, 95%CI: 1.002-1.013, P<0.05) were independent risk factors for moderate-to-severe TRAS. ROC curve analysis for lipoprotein a showed that the area under the curve was 0.771 (95%CI: 0.597-0.946, P<0.05), and the optimal cutoff value was 74.95 nmol/L. In the TRAS group, 9 patients were stented, 2 patients were treated with balloon dilatation alone, and 5 patients were treated with balloon dilatation combined with stent implantation; serum creatinine at 3, 7, 14, 28 days and 2, 3 months after interventional therapy was significantly different from that before surgery (t=2.959, 3.354, 2.795, 3.148, 3.040, and 3.721, P<0.05).

Patients with moderate-to-severe TRAS after kidney transplantation exhibit higher neutrophil ratios, more severe anemia, and significantly elevated serum urea nitrogen, creatinine, and cystatin levels. Interventional therapy can significantly improve renal function in such patients. Patients with re-transplantation and lipoprotein a levels >74.95 nmol/L were at higher risk of moderate-to-severe TRAS.

To establish a fluorescence quantitative PCR (qPCR) assay for detecting Torque teno virus (TTV) in human blood and evaluate its role in assessing immune function in kidney transplant recipients.

Based on the TTV standard nucleic acid sequence published in the NCBI (the national center for biotechnology information) database, primers and probes were designed for the UTR region.This region was artificially synthesized and integrated into a plasmid as a detection standard. Reaction conditions, including annealing temperature, primer concentration, and probe concentration, were optimized to establish a standard curve for TTV qPCR detection. Clinical blood samples from 108 kidney transplant recipients and candidates awaiting transplantation were collected from the Transplant Medicine Center of Wuhan University and divided into stable, rejection, pre-transplant, and infection groups based on clinical status. TTV load was measured, and the diagnostic value of TTV copy number for post-transplant infection and rejection was evaluated using receiver operating characteristic (ROC) curve analysis.

The optimized qPCR conditions were determined as an annealing temperature of 56 ℃, with 1 μL each of primers and probes. Under these conditions, a standard curve was generated using standard templates ranging from 9 to 3 log copies/μL, yielding a coefficient of determination R²=0.999, slope=-3.320, intercept=42.28, amplification efficiency=100.1%, and a lower detection limit of 1 log copies/μL. qPCR testing of 108 patient plasma samples revealed correlations between TTV load and infection or rejection. The TTV load in the stable group was 5.125 (4.550, 5.491) log copies/μL, increased in the infection group to 5.888 (5.135, 6.506) log copies/μL, decreased in the rejection group to 4.167 (3.459-4.869) log copies/μL, and was lowest in the pre-transplant group at 2.885 (2.636, 3.233) log copies/μL, with statistically significant differences (P<0.05). The area under the ROC curve (AUC) for TTV load in diagnosing rejection was 0.7875 (P<0.05), with an optimal cutoff value of 4.999 log copies/μL at the maximum Youden index. For diagnosing infection, the AUC was 0.7458 (P<0.05), with an optimal cutoff value of 5.770 log copies/μL.

The established TTV qPCR assay demonstrates good sensitivity and specificity for detecting TTV in human whole blood. A TTV load below 9.98×10⁴ copies/μL indicates a higher risk of rejection, while a load above 5.89×10⁵ copies/μL suggests a higher risk of infection.

With the increasing treatment demands of patients with type 1 diabetes mellitus, pancreatic islet transplantation has emerged as a promising curative therapeutic approach. However, the expansion of donor pools remains a critical challenge for its clinical application. Based on the latest research findings both domestically and internationally, this study systematically explores the application prospects of human-derived islet cells, xenogeneic islet cells, artificial islet cells, and islet organoids in donor pool expansion. Research indicates that human-derived cardiac islet cells, autologous islet cells, and live donors offer diverse options; gene-edited pig islet cells exhibit significant potential in xenotransplantation; stem cell differentiation technologies and direct reprogramming strategies have made the generation of artificial islet cells feasible; and islet organoids, through 3D bioprinting and tissue engineering technologies, further optimize the structure and function of islet-like constructs. However, challenges such as immune rejection and the long-term maintenance of graft functionality remain major obstacles to current technologies. By optimizing donor cell sources, improving immunotolerance strategies, and integrating gene editing with regenerative medicine technologies, the clinical translation prospects of these emerging approaches are becoming increasingly clear. Future research should focus on technological optimization and safety evaluation to provide novel pathways for expanding donor pools and enhancing the clinical efficacy of islet transplantation.