In clinical liver transplantation practice, particularly when dealing with low body weight recipients, the limited availability of size-matched donor grafts often necessitates the use of relatively large grafts to complete the transplantation. However, such graft-to-recipient size mismatch significantly increases the risk of developing large-for-size syndrome (LFSS) after liver transplantation. LFSS refers to a spectrum of complications resulting from excessive graft volume or thickness, leading to intra-abdominal compartmentalization, portal venous inflow restriction, hepatic venous outflow obstruction, and impaired graft function. It is especially prevalent in infant recipients, where management is more complex and associated with higher complication rates. To guide accurate clinical recognition, effective prevention, and standardized intervention of LFSS, the Liver Transplantation Group, Branch of Organ Transplant of the Chinese Medical Association and the Branch of Organ Transplant Physicians of the Chinese Medical Doctor Association convened national experts to develop the Chinese clinical practice guideline for prevention and treatment of large-for-size syndrome in liver transplantation (2025 edition), based on a comprehensive review of international and domestic research advances. The guideline adopts the 2009 Oxford Centre for Evidence-Based Medicine levels of evidence system and provides structured recommendations covering the definition and clinical manifestations of LFSS, key assessment parameters, surgical preventive strategies, postoperative monitoring, and multidisciplinary interventions. Emphasizing a "prevention-focused, intervention-supported" therapeutic principle, the guideline advocates for individualized graft-recipient matching and refined surgical techniques. Its implementation aims to standardize LFSS clinical management, enhance the overall safety and success rate of liver transplantation in China, and promote high-quality development of both adult and pediatric liver transplant techniques.

Recurrence and metastasis after liver transplantation for hepatocellular carcinoma (HCC) remain the major challenge affecting the long-term survival of patients. To address this, the Branch of Organ Transplantation of Chinese Medical Association, in conjunction with experts from relevant fields, formulated the Chinese Expert Consensus on Prevention and Treatment of Recurrence and Metastasis after Liver Transplantation for Hepatocellular Carcinoma (2025 Edition) based on evidence-based medicine and GRADE system following in-depth deliberation. The consensus aims to provide scientific guidance for clinical practice of liver transplantation in China. It emphasizes the importance of personalized treatment strategies, proposes optimizing immunosuppressive strategies and various adjuvant therapies to reduce recurrence risk, and compares the indications and potential risks of surgical, locoregional, and systemic therapies. It also systematically summarizes the identification of high-risk groups, predictive factors, novel biomarkers, prognostic models, prevention strategies, monitoring protocols, diagnostic methods, and treatment pathways for recurrence and metastasis after liver transplantation for HCC, with the goal of improving postoperative survival rate and quality of life of patients.

To establish a novel mouse model of chronic renal allograft rejection.

C57BL/6 and Balb/c mice were selected as experimental animals to establish three groups: syngeneic control group, conventional allograft group and novel allograft group. Post-operative serum creatinine and blood urea nitrogen levels were monitored regularly. At 16 weeks post-transplantation, graft tissues were harvested for pathological assessment and deep phenotypic analysis. The Banff scoring system was used to evaluate renal allograft pathology. Raw sequencing data were processed using CellRanger 3.1 software. Major cell types were identified and annotated by comparing gene expression profiles with publicly available cell-type-specific gene databases. Cell cycle scoring was performed using the CellCycleScoring function in the Seurat package. Gene Ontology (GO) functional enrichment analysis was conducted using the ClusterProfiler package in R. Comparisons of normally distributed quantitative data were performed using one-way analysis of variance, while non-normally distributed data were analyzed using the Kruskal-Wallis H test. Categorical data were compared using the Chi-square test. Survival curve was generated using the Kaplan-Meier method and compared using the Log-rank test. A P-value <0.05 was considered statistically significant.

Serum creatinine (except at 8 weeks post-transplantation) and blood urea nitrogen levels in the novel allograft group were significantly higher than those in the syngeneic control and conventional allograft group at various post-operative time points (all P<0.05). Pathological analysis showed statistically significant differences in Banff scores for interstitial fibrosis, tubular atrophy, vascular fibrous intimal thickening, and transplant glomerulopathy among the syngeneic control, novel allograft, and conventional allograft groups (H=24.385, 24.120, 23.550 and 26.840, respectively, all P<0.05). Significant differences were observed in the fibrosis area and lymphocyte infiltration rate among the novel allograft, conventional allograft, and syngeneic control group (F=129.071 and 9.543, respectively, all P<0.05). Semi-quantitative analysis of immunohistochemical staining revealed statistically significant differences in the positive areas of Collagen-Ⅲ, alpha-smooth muscle actin, CD3 and CD19 among the three groups (F=740.142, 223.663, 106.611 and 1 026.355, respectively, all P<0.05). Immunofluorescence staining results indicated stronger infiltration of monocytes and macrophages in the graft tissues of the novel allograft group compared to the syngeneic control group. Cell type identification and annotation showed that epithelial cells dominated in the syngeneic control group, whereas the novel allograft group exhibited a higher proportion of immune cells. Single-cell sequencing analysis demonstrated a significant increase in the proportion of immune cells in the novel allograft group; cell cycle analysis suggested that cells in this group were predominantly in the active proliferative G2M and S phases. Gene set variation analysis and GO analysis showed significant upregulation of Hallmark gene sets related to immune activation in the novel allograft group.

The novel chronic renal allograft rejection mouse model effectively recapitulates the processes of chronic allograft rejection and renal interstitial fibrosis.

To investigate the myocardial expression of S100 calcium-binding proteins A8/A9 (S100A8/A9) in gene-edited pig donors before and after heterotopic cardiac xenotransplantation, and to delineate their relationship with macrophage-mediated inflammatory responses.

Three Bama gene-edited pigs were selected as donors and three adult male rhesus macaques served as recipients; heterotopic cardiac xenotransplantation was performed. Western blotting (WB) was employed to quantify the protein levels of S100A8/A9, inducible nitric-oxide synthase (iNOS), arginase-1 (Arg-1), TNF-α, IL-18, TGF-β, and IL-10. Immunohistochemical staining was performed to evaluate the tissue expression of CD3, CD19, and CD68. Between-group comparisons of normally distributed continuous data were performed using the independent-samples t-test, whereas the Wilcoxon signed-rank test was used for non-normally distributed continuous data. A P-value <0.05 was considered statistically significant.

Both donor and recipient hearts were successfully reperfused. WB analysis revealed that the relative expression levels of S100A8 in porcine cardiac tissue before and after transplantation were (1.000±0.000) and (3.234±0.790), respectively, while those of S100A9 were (1.000±0.000) and (2.796±0.617), respectively; the differences were statistically significant (t=-4.893 and -5.042, all P<0.05). HE staining showed extensive cardiomyocyte necrosis, hemorrhage, and inflammatory-cell infiltration in the transplanted gene-edited pig hearts. Immunohistochemical staining showed positive CD68 expression in the myocardial tissue of the gene-edited pig after transplantation. In all three recipient monkeys, the peripheral blood monocyte ratio did not exhibit a sustained postoperative increase. The relative expression levels of iNOS in porcine cardiac tissue before and after transplantation were (1.000±0.000) and (13.763±0.229), respectively, while those of Arg-1 were (1.000±0.000) and (0.143±0.071), respectively; the differences were statistically significant (t=-96.518 and 20.930, all P<0.05). Before transplantation, the relative expression levels of TNF-α, IL-18, TGF-β and IL-10 in porcine cardiac tissue were all (1.000±0.000); and the relative expression levels of them were (1.447±0.108), (3.656±0.596), (0.741±0.034), and (0.682±0.049) after transplantation, with statistically significant differences (t=-7.126, -7.725, 13.164 and 11.178, all P<0.05).

The expression of S100A8/A9, iNOS, and pro-inflammatory cytokines in gene-edited pig donor hearts was markedly up-regulated, whereas anti-inflammatory markers were down-regulated, indicating that S100A8/A9 may exacerbate the inflammatory response in cardiac xenografts by promoting macrophage M1 polarization.

To investigate the association between bronchoscopy frequency and successful lung procurement among potential brain-dead donors, and to evaluate its potential impact on donor lung quality and safety, with the aim of providing evidence to optimize donor management strategies.

A retrospective analysis was conducted on 251 potential brain-dead donors who underwent organ donation in the intensive care unit of Sun Yat-sen Memorial Hospital, Sun Yat-sen University, between January 2020 and January 2024. According to the frequency of bronchoscopic procedures performed during hospitalization, donors were divided into a low-frequency group (n=131) and a high-frequency group (n=120). Propensity score matching (PSM) was performed at a 1 ∶1 ratio, yielding 77 matched donors in each group. Baseline characteristics were systematically collected using the hospital′s artificial intelligence–based big data platform. Continuous variables with normal distribution were compared using independent-sample t tests, whereas non-normally distributed variables were compared using the Mann-Whitney U test. Categorical variables were compared using the chi-square test or Fisher′s exact test. Multivariable Logistic regression, propensity score-adjusted Logistic regression, and weighted models were applied to examine the association between bronchoscopy frequency and successful lung procurement. A P value <0.05 was considered statistically significant.

Before PSM, the successful lung procurement rates were 30.5% (40/131) in the low-frequency group and 41.7% (50/120) in the high-frequency group. After PSM, the corresponding rates were 28.6% (22/77) and 42.9% (33/77), respectively. Substantial differences in baseline characteristics between the two groups were observed before matching, which were markedly reduced after PSM. In the unadjusted regression model, no statistically significant difference in successful lung procurement rate was observed between groups (P>0.05). However, multivariable Logistic regression analysis showed a significantly higher likelihood of successful lung procurement rate in the high-frequency group (OR=3.33, 95%CI: 1.66-6.67; P<0.05). Consistent results were obtained using propensity score-adjusted Logistic regression model (OR=2.29, 95%CI: 1.27-4.15), inverse probability weighting model (OR=2.18, 95%CI: 1.29-3.69), standardized mortality ratio weighting model (OR=2.13, 95%CI: 1.24-3.66), and stratified weighting model (OR=3.33, 95%CI: 1.66-6.67), all indicating significantly higher procurement success rates in the high-frequency group (all P<0.05). After PSM, no significant difference was observed between the two groups in pre-donation coagulation parameters, infection-related markers, or ventilator settings (all P>0.05).

A higher frequency of bronchoscopic procedures was associated with an increased rate of successful lung procurement among potential brain-dead donors, without a significant increase in airway-related or systemic complications.

To investigate the effects of exosomes (Exo) derived from human induced pluripotent stem cells (hiPSCs) on renal ischemia-reperfusion injury (IRI).

HiPSCs were cultured, and Exo were isolated from the supernatant by ultracentrifugation. The isolated Exo were characterized by detecting the specific markers CD9, CD63, CD81 and the negative marker Calnexin via Western blot (WB), observing their morphology by transmission electron microscopy, and analyzing particle size via nanoparticle tracking analysis. SD rats were randomly assigned to four groups (n=6 per group): sham-operated group, IRI group, IhiPSCs group, and IhiPSCs-Exo group. At 48 hours post-intervention, serum creatinine (Scr) and blood urea nitrogen (BUN) levels were measured, and renal pathological sections were stained with hematoxylin and eosin for evaluation using a modified Paller tubular injury score. The mRNA expression levels of IL-1β, TNF-α, SOD-2, and Nrf-2 were determined by quantitative real-time polymerase chain reaction. The protein expression of CD163, CD68, α-SMA, COL-1, and FN-1 was assessed by immunohistochemistry. WB was performed to determine the protein expression levels of p-MEK1/2, p-ERK1/2, Caspase-3, Bcl-2, and Bax. Using human renal tubular epithelial cells (HK-2 cells), a hypoxia/reoxygenation (H/R) model was established, including H/R group and H/R + hiPSCs-Exo group. Cell proliferation was measured by CCK-8 assay, apoptosis was detected by Annexin V-FITC/PI staining, and the expression of Caspase-3, Bcl-2, and Bax was analyzed by WB. One-way analysis of variance was used for comparisons between groups, and further pairwise comparisons were conducted using the Tukey HSD test, with a P value <0.05 considered statistically significant.

The isolated Exo exhibited a typical cup-shaped morphology with a double-membrane structure, an average particle size of (88.0±0.6) nm, and expressed the specific marker proteins CD9, CD63, and CD81. In vivo experiments showed that compared with the IRI group, the IhiPSCs group and IhiPSCs-Exo group exhibited significantly lower levels of Scr, BUN, and modified Paller tubular injury scores (all P<0.05). Furthermore, these groups showed decreased mRNA levels of IL-1β and TNF-α, increased mRNA levels of SOD-2 and Nrf-2, reduced protein expression of CD68, α-SMA, COL-1, and FN-1 by immunohistochemistry, and elevated protein expression of CD163 (all P<0.05). WB analysis revealed that compared with the IRI group, the relative protein expression levels of p-MEK1/2, p-ERK1/2, Caspase-3, and Bax were decreased, while the expression of Bcl-2 was increased in the IhiPSCs group and IhiPSCs-Exo group (all P<0.05). In vitro experiments demonstrated that compared with the H/R group, the hiPSCs-Exo group showed enhanced HK-2 cell proliferation, reduced numbers of apoptotic and necrotic cells, decreased protein expression of Caspase-3 and Bax, and increased expression of Bcl-2.

Exo derived from hiPSCs exert a protective effect against renal IRI through multiple pathways, including the suppression of oxidative stress, inflammatory factor expression, and apoptosis. This protective effect is associated with the inhibition of the MEK/ERK signaling pathway.

To evaluate the risk factors and clinical diagnosis and treatment strategies for post-kidney-transplantation diarrhea in the Northwest China.

A retrospective analysis was conducted among 230 kidney transplant recipients from the Department of Urology, the First Affiliated Hospital of Air Force Medical University from January 2019 to December 2024. Recipients were divided into the diarrhea group (n=72) and non-diarrhea group (n=158). General information and treatment of the recipients were recorded. Comparisons were made using the group t-test for normally distributed continuous variables, and the chi-square test was used for categorical variables. Variables significant at P<0.05 in univariate analysis were included in multivariate Logistic regression analysis. Statistical significance was set at P<0.05.

Among the 67 recipients (93.1%) with acute diarrhea, overall renal impact and clinical outcomes were relatively mild. Of these acute cases, 2 had SARS-CoV-2 infection, 1 had CMV infection, and 1 had positive fecal transferrin. Chronic diarrhea occurred in 5 cases (6.9%): 1 recipient died of severe hypokalemia; 3 recipients experienced deterioration of renal function, with 2 developed focal segmental glomerulosclerosis and IgA nephropathy recurrence who gradually leading to graft failure and returning to dialysis; 1 maintained stable serum creatinine of 200-300 μmol/L; 1 achieved completely recovery after treatment. Among the 5 cases with chronic diarrhea, 1 had CMV infection, 2 had positive fecal occult blood, and 1 had clostridioides difficile infection. Diarrhea occurred beyond the first year posttransplant in 12 cases (16.7%), while the remaining cases manifested within the first year after transplantation. Significant differences were observed between groups in duration of hospital stay, body mass index, presence of hyperlipidemia, operation time, complicated with delayed graft function (DGF) after transplantation, last preoperative serum potassium and creatinine, mycophenolic acid type and smoking history (t/χ²=4.100, 2.441, 2.548, 3.688, 4.076, -2.197, 2.755, 7.530 and -2.135, all P<0.05). The results of multivariate Logistic regression analysis showed that hospital stay (OR=1.062, 95% CI: 1.008-1.118), hyperlipidemia (OR=2.796, 95% CI: 1.427-5.478), operation time (OR=1.023, 95% CI: 1.010-1.036), postoperative DGF (OR=3.057, 95% CI: 1.414-6.607), last preoperative serum potassium (OR=0.556, 95% CI: 0.372-0.830), last preoperative serum creatinine (OR=1.002, 95% CI: 1.001-1.003), application of mycophenolate mofetil (OR=7.493, 95% CI: 3.528-15.913), and smoking history (OR=2.167, 95% CI: 1.102-4.259) were all independent risk factors for diarrhea after kidney transplantation (all P<005).

Post-kidney transplantation diarrhea is influenced by multiple complex factors in Northwest China. In-depth understanding of these factors may facilitate the development of targeted and precise prevention and treatment strategies.

To explore the real employment experience of young and middle-aged lung transplant recipients returning to work, so as to provide reference for formulating intervention strategies for young and middle-aged lung transplant recipients returning to work.

Phenomenological research method was used to conduct semi-structured interviews with 13 young and middle-aged lung transplant recipients who had returned to work. Colaizzi 7-step analysis method was used to analyze the interview data and refine the theme.

The real experience of young and middle-aged recipients returning to work after lung transplantation could be summarized into 3 themes and 9 sub-themes: the perceived adverse experience before returning to work (negative and emotional experiences limited returning to work, social apathy precluded returning to work), an overall positive experience facilitated returning to work (good self-management promoted physical and mental rehabilitation, the experience of physical wellness ensured returning to work, positive emotional adjustment inspired to return to work, perception of social support promoted returning to work), returning to work successfully achieved self-actualization (successfully returning to work increased positive emotion, lightened the economic burden of family, realised personal value).

Although young and middle-aged lung transplant recipients face obstacles and challenges before returning to work, returning to work is conducive to improving physical and mental health. It is recommended to integrate multiple forces to optimize the social support system to promote recipients to return to work and employment.

Shanxi Organ Procurement Organization (OPO) was founded as the first independent provincial OPO in China, the "Shanxi Model" provided a solution for the standardization of organ procurement in China. In 2020, a Scientific Committee was established within our OPO. Multidisciplinary experts were brought together to provide guidance on the direction of the scientific research. Various kinds of consultations were made with relevant professionals to carry out scientific research programs and formulate expert consensus. Through combining research results with clinical experience, we tried to figure out how to inspire the networks supporting organ donation and procurement. This paper explored the direction of professionalism of organ donation and the development of our OPO, providing detailed insights into talent cultivation, theoretical framework construction, international cooperation, as well as data transformation. With the aim of adhering to the principles of standardized and high-quality development of organ donation, we tried to continuously advance the scientific construction of our OPO and thereby promoted the professional development of organ donation.

To analyze the effect of the special laparotomy sheet for organ procurement surgeries in organ procurement surgery.

A total of 172 donors who underwent donor organ procurement surgeries in the First Affiliated Hospital of Xi′an Jiaotong University were selected as the research objects. From January 1, 2024 to May 31, 2024, 86 cases of donor organ procurement surgeries using traditional laparotomy sheet were set as the control group. From June 1, 2024 to October 31, 2024, a total of 86 cases with special laparotomy sheet for donor organ procurement surgeries were set as the observation group. The basic information of the two groups of donors, the damage ratio, the wet area after use, and the satisfaction of medical staff with the use of laparotomy sheets of the two groups of donors were analyzed. The group t-test was used for comparison for normal distribution measurement data between groups, and the chi-square test was used for comparison for count data between groups. A P value <0.05 was considered statistically significant.

There were no statistically significant differences in the gender, age and body mass index of donors between the observation group and the control group (χ²=1.63, t=1.88 and 0.19, all P > 0.05). The proportion of damaged laparotomy sheets after surgeries in observation group and control group was 1.2% (1/86) and 16.3% (14/86), respectively, and the difference was statistically significant (χ²=12.34, P<0.05). The wet area of laparotomy sheet and the satisfaction score of medical staff in the observation group were (0.25±0.06) m² and (90.1±3.6) points, respectively, while those in the control group were (0.29±0.09) m² and (79.5±4.9) points, respectively. The differences were statistically significant (t=3.13 and 10.85, all P<0.05).

The special laparotomy sheet for organ procurement surgery can provide convenience for organ procurement operation, and reduce the damage ratio, and improve the job satisfaction of medical staff.

Lung transplantation is a key treatment for end-stage lung diseases, yet postoperative complications often significantly affect long-term survival of recipients. In recent years, the role of the respiratory microbiota in lung transplantation outcomes has gained increasing attention, offering new perspectives for understanding and intervening in post-transplant complications. This article systematically reviews the dynamic changes in the respiratory microbiota of lung transplant recipients from the perioperative period through long-term recovery. Findings indicate that during the perioperative phase, various end-stage lung diseases already exhibit microbiota dysbiosis, characterized by reduced alpha-diversity and enrichment of specific bacterial species. Postoperatively, the microbiota demonstrates temporal and spatial heterogeneity, with changes in its diversity and microbial load correlating with multiple complications. Evidence suggests that microbiota imbalance may exacerbate local inflammation and fibrosis in the lung graft through metabolite-immune interactions, highlighting the potential clinical value of microbiota-targeted interventions. However, establishing long-term dynamic monitoring systems for the microbiota, validating underlying mechanisms, and developing individualized regulatory strategies remain important challenges. Moving forward, integrating multiomics technologies will be essential to advance the field from descriptive observations toward mechanistic insight and clinical translation.

Colorectal cancer is among the most common malignancies worldwide, and nearly half of patients will develop colorectal liver metastases (CRLM). Over the past three decades, systemic therapy and hepatic resection have remained the cornerstone treatment strategies for CRLM. However, only about 20% of cases are amenable to curative-intent resection. The prognosis of nonresectable colorectal liver metastases (nrCRLM) is dismal, with 5-year overall survival approaching zero. In the 1980s, surgeons attempted to extend liver transplantation to patients with nrCRLM, but this approach was largely abandoned because of high perioperative mortality and frequent post-transplant recurrence. With continued advances in systemic therapy and transplant techniques, accumulating evidence indicates that, in carefully selected patients with nrCRLM, liver transplantation can achieve 5-year overall survival of up to 60%, suggesting a potential long-term survival benefit in selected populations and positioning transplantation as a potentially curative option for a subset of patients. This review summarizes recent progress in liver transplantation for nrCRLM, focusing on its historical development, prognostic factors, recipient selection criteria and key challenges related to organ scarcity and allocation policies.

Liver transplantation remains the sole definitive therapy for end-stage liver disease, and biliary complications are among common postoperative issues following transplantation. This review summarizes relevant advances in biliary complications over recent years, and delineates the risk factors, classification, clinical presentation, diagnostic strategies and therapeutic approaches in biliary complications after liver transplantation. The aim is to provide valuable insights into addressing clinical challenges associated with biliary complications, ultimately enhancing the quality of life for liver transplant recipients.

With the development of technology and the informatization of medical big data, artificial intelligence (AI) and machine learning have been increasingly applied in the medical field. With continuous improvements in surgical techniques of kidney transplantation and the progression towards individualized and refined perioperative and postoperative management, quality of life and long-term prognosis have significantly improved. AI technologies are gradually transforming traditional practice in kidney transplantation management. This article comprehensively analyzes the latest research findings on the application of AI in kidney transplantation in the areas of donor-recipient matching, surgical assistance, prediction of postoperative complications, and immunosuppressant management both domestically and internationally. The aim is to promote further research and facilitate the application of AI in the field of kidney transplantation, ultimately improving outcomes for more kidney transplant patients.