With the advancement of surgical techniques and refinement of perioperative management, the long-term survival rate of liver transplant recipients has significantly improved, making the management of de novo malignancy (DNM) increasingly critical. Compared with the general population, adult liver transplant recipients suffered from an approximately 10-fold higher risk of developing DNM and a 2- to 3-fold higher risk of mortality. DNM has become the most common cause of death for recipients surviving more than 10 years after transplantation. To standardize and optimize the diagnosis, therapeutics, and management of DNM in adult liver transplant recipients, the Branch of Organ Transplantation of Chinese Medical Association and Branch of Organ Transplant Physicians of Chinese Medical Doctor Association organize experts to systematically review and analyze domestic and international evidence-based medical data, combined with clinical practical experience in China, and establish the Clinical practice guideline for diagnosis and treatment of de novo malignancy in adult liver transplantation recipient (2026 edition). This guideline elucidates the epidemiological characteristics, risk factors, screening strategies, prevention and therapeutic principles of DNM in adult liver transplant recipients, and proposes a series of scientific recommendations, aiming to improve the post-transplant quality of life and long-term survival rates.

To systematically analyze the publication characteristics, research hotspots, and international collaboration patterns in the field of organ donation and transplantation worldwide from 2016 to 2025 based on the Web of Science Core Collection (WoSCC) database, and to provide decision-making references for discipline development and internationalization.

Literature was retrieved from the WoSCC database using a topic-search strategy. The R package Bibliometrix and Biblioshiny platform were used to perform bibliometric and visualization analyses of annual publication trends, core source journals, author and country collaboration networks, keyword co-occurrence, and the topological relationships of document co-citation.

A total of 4 771 articles related to organ donation and transplantation from 2016 to 2025 were included from the WoSCC database, comprising 4 223 articles and 548 reviews. Over the past decade, the annual publication volume showed an overall fluctuating upward trend, with a compound annual growth rate of 2.76%, reaching its peak in 2021 (565 articles). The proportion of international co-authored articles was 18.13%, and the average number of co-authors per article was 8.56. High-frequency keyword analysis showed that kidney transplantation, liver transplantation, living donor, donation after cardiac death, and clinical practice were the core themes in this field. Keyword co-occurrence analysis indicated that " transplantation" had the highest betweenness centrality value (32.369), serving as a significant global hub. Technical terms such as " machine perfusion" and " preservation" had relatively low betweenness centrality values. Combined with the analysis of highly cited literature, organ preservation and machine perfusion technologies have become key emerging frontiers. Document co-citation analysis showed that the knowledge base of the field is mainly built upon reports from international registries, clinical guidelines, and conventional donor classification criteria. The country collaboration network showed that the United States occupied an absolutely central position, with a betweenness centrality value of 9.386 and a weight of 0.117. European countries such as the United Kingdom and Germany demonstrated strong intermediary effects in the collaboration network. China showed a relatively high volume of research output, but its betweenness centrality value in the collaboration network was low (0.099).

Global research on organ donation and transplantation is undergoing a multidimensional transition from a primary focus on surgical clinical outcome evaluation toward precision management of donor quality, standardization of donation after cardiac death criteria and protocols, optimization of organ perfusion technologies, and the development of ethical and sociological governance systems. China has established a certain research foundation in this field. However, there remains considerable room for improvement in its hub position within the international collaboration network.

To investigate postoperative hepatitis B recurrence and its risk factors in liver transplant recipients with HBV-related end-stage liver disease.

Clinical data of 138 recipients, who underwent liver transplantation for HBV-related end-stage liver disease at the First Affiliated Hospital of Anhui Medical University from January 2016 to December 2024, were retrospectively collected. Recipients were divided into a recurrence group (n=13) and a non-recurrence group (n=125) based on the presence or absence of postoperative hepatitis B recurrence. The homogeneity of variances between the two groups was assessed using Levene′s test. When variances were equal (P>0.05), comparisons between groups were performed using the group t-test; when variances were unequal (P≤0.05), the adjusted t-test was used. For continuous data with a non-normal distribution, the Mann-Whitney U test was used for intergroup comparisons. Categorical data were compared using the chi-square test. Logistic regression analysis was used to identify risk factors for postoperative hepatitis B recurrence. Survival curves were plotted using the Kaplan-Meier method and compared using the log-rank test. A P-value < 0.05 was considered statistically significant.

Follow-up was conducted until December 31, 2025, with a median follow-up duration of 39.8 (7.7, 116.7) months. Statistically significant differences were observed between the two groups in mean serum tacrolimus concentration [(9.54±1.87) and (7.97±2.22) ng/mL] within the first postoperative year and the incidence [84.6%(11/13) and 53.6% (67/125) ] of postoperative complications (t=-2.461, χ²=4.609, all P<0.05). Multivariate logistic regression analysis revealed that serum tacrolimus concentration within the first postoperative year (OR=1.500, 95%CI: 1.050-2.141) was an independent risk factor for postoperative hepatitis B recurrence in HBV-related liver transplant recipients (P<0.05). The 1-, 3-, and 5-year cumulative overall survival rates for the 138 recipients were 97.8%, 90.7% and 81.7%, respectively. During follow-up, three recipients in the recurrence group died due to intrahepatic recurrence of hepatocellular carcinoma, intrahepatic hepatocellular carcinoma recurrence with pulmonary metastasis, and fulminant liver failure caused by HBV reactivation. There were 14 recipients died in the non-recurrence group: 4 died of multiple organ failure, 3 died of liver failure caused by disease progression following hepatocellular carcinoma recurrence, 3 died of liver failure secondary to immune rejection, 3 died of biliary complications, and 1 died of gastrointestinal hemorrhage. The 1-, 3-, and 5-year cumulative survival rates of recipients were 92.3%, 84.6% and 76.2% in the recurrence group, and 97.6%, 91.5% and 82.5% in the non-recurrence group. The log-rank test showed no statistically significant difference in cumulative survival was observed between the two groups at follow-up endpoint(χ²=0.709, P>0.05).

Higher mean serum tacrolimus concentration within the first postoperative year may be a risk factor for postoperative hepatitis B recurrence in liver transplant recipients with HBV-related disease.

To evaluate the preoperative nutritional status of pediatric liver transplant recipients, explore its correlations with early postoperative recovery course and short-term clinical outcomes, and provide empirical evidence for targeted precise perioperative nutritional intervention.

A prospective study was performed. Clinical data of 309 children who underwent liver transplantation at the First Affiliated Hospital, Zhejiang University School of Medicine between January 2023 and August 2025 were collected. Preoperative nutritional status was assessed according to the Growth Standards for Children Under 7 Years Old. Patients were divided into a malnutrition group (n=197) and a well-nourished group (n=112). In addition, all subjects were stratified into two groups based on postoperative ICU stay duration: ≤5 days group (n=152) and >5 days group (n=157). Early prognostic indicators, including time to first postoperative feeding and length of ICU stay, as well as hematological parameters on postoperative day 7, were compared between the two nutritional groups. The t-test was used for intergroup comparison of normally distributed measurement data, the Mann-Whitney U test was applied for non-normally distributed measurement data. Spearman′s rank correlation analysis was conducted to analyze the correlations between preoperative nutritional status scores and early postoperative clinical indicators, and stratified analyses were performed based on whether ICU stay exceeded 5 days. P<0.05 was defined as statistically significant.

The incidence of preoperative malnutrition among the 309 pediatric liver transplant recipients was 63.8% (197/309). Median time to first postoperative feeding was significantly shorter in the well-nourished group [6.0 (5.0, 10.0) days] than that in the malnutrition group [7.0 (6.0, 11.0) days]. On postoperative day 7, the well-nourished group had higher ALT, AST and gamma-glutamyltransferase (GGT) levels [128.0 (79.5, 229.5), 55.5 (36.0, 89.0), 137.5 (76.3, 231.8) U/L] compared with the malnutrition group [110.0 (60.0, 174.0), 46.0 (30.0, 77.0), 104.0 (65.0, 167.0) U/L]. By contrast, white blood cell count and lymphocyte count were lower in the well-nourished group [9.7 (6.5, 14.4)×10⁹/L, 3.1 (1.6, 5.5)×10⁹/L] versus the malnutrition group [11.1 (7.9, 14.7)×10⁹/L, 4.0 (2.4, 6.7) ×10⁹/L]. All intergroup differences were statistically significant (Z=5.592, 5.503, 4.181, 8.792, 4.086, 4.696; all P<0.05). Preoperative nutritional status scores were negatively correlated with time to first postoperative feeding, early postoperative lymphocyte count and white blood cell count (r=-0.135, -0.123, -0.115; all P<0.05), and positively correlated with early postoperative ALT (r=0.134), AST (r=0.117) and GGT (r=0.169) levels (all P< 0.05). Stratified analyses demonstrated that in children with ICU stay ≤5 days, preoperative nutritional status scores were negatively correlated with duration of mechanical ventilation and time to first postoperative feeding (r=-0.192, -0.149; all P<0.05), and positively correlated with postoperative GGT levels (r=0.198; P<0.05). Among patients with ICU stay >5 days, preoperative nutritional status scores were negatively correlated with early postoperative lymphocyte count and white blood cell count (r=-0.216, -0.195; all P<0.05), and positively correlated with postoperative GGT levels (r=0.171; P<0.05).

Preoperative malnutrition is highly prevalent in pediatric liver transplant recipients, and it is closely associated with delayed recovery of postoperative gastrointestinal function, inflammatory response aggravation and changes in liver function parameters. The favorable preoperative nutritional status facilitates the recovery of respiratory function in children with short ICU hospitalization; whereas malnutrition significantly impairs postoperative immune regulation in patients requiring prolonged ICU stay.

To investigate the immune response, cardiac functional changes, and tissue remodeling following xenotransplantation of gene-edited pig hearts into rhesus macaques under current immunosuppressive strategies.

A pig-to-rhesus macaque heterotopic heart xenotransplantation model was established using a donor pig with five genes modifications (α-1, 3-galactosyltransferase/β-1, 4-N-acetylgalactosaminyltransferase 2/human CD46 transgene/human CD55 transgene/human thrombomodulin transgene). The immunosuppressive regimen comprised induction and maintenance phases and was based on anti-CD154 antibody and methylprednisolone. During the induction phase, anti-CD20 antibody, antithymocyte globulin, and cobra venom factor were additionally administered. During the maintenance phase, mycophenolate mofetil was added and methylprednisolone was gradually tapered. In the event of acute rejection, intensified methylprednisolone therapy was administered. Postoperative assessments included physiological parameters, cardiac function, immune cell dynamics, and histological features of the recipient monkey.

The recipient monkey survived for 46 days after transplantation. The recipient′s general condition remained relatively stable during the perioperative and early postoperative periods, with no hyperacute or acute rejection observed. Both the donor and recipient hearts maintained effective contractility after transplantation. The left ventricular ejection fraction of the recipient monkey′s native heart remained above 50% throughout the study, whereas that of the donor porcine heart was generally lower. Progressive thickening of the left and right ventricular endocardium was observed in the donor heart, reaching approximately threefold above baseline by the experimental endpoint. Leukocyte counts increased during the early postoperative period, whereas erythrocyte and platelet counts showed no sustained decline. Aminotransferase, total bilirubin, coagulation parameters, and troponin levels fluctuated over different postoperative phases. Immunohistochemistry showed higher CD68 and IgG Fc expression in porcine myocardium than in monkey myocardium. Flow cytometry showed that the proportion of peripheral blood CD3⁺ CD19^- cells increased to 74.9% on postoperative day 5, and thereafter remained between 76.2% and 89.7%. The proportion of CD3^-CD19^- cells decreased from 89.2% on the day of surgery to 81.7% on postoperative day 1, and thereafter remained between 10.2% and 25.0%. The proportion of CD3^-CD19⁺ cells remained below 0.1% throughout the observation period. The proportion of CD3⁺ CD19⁺ cells increased to 3.4% on postoperative day 7, with no marked increase observed at the other time points.

T cell-mediated cellular immune responses are the primary drivers of graft structural changes and functional deterioration under effective humoral immune suppression.

Acute-on-chronic liver failure (ACLF) is a severe syndrome characterized by acute decompensation due to triggers such as infection or alcohol abuse in patients with chronic liver disease, marked by rapid deterioration of liver function accompanied by multiple organ failure and high short-term mortality. Effective therapeutic options are currently lacking, and liver transplantation remains the only life-saving intervention, which can achieve favorable outcomes in strictly selected patients, although prognosis is influenced by multiple factors. Given the high incidence of ACLF, persistent shortage of donor livers, and expanding indications for liver transplantation, the role of liver transplantation in ACLF remains controversial. This article reviews the etiology, diagnosis, and prognostic models of ACLF, and systematically analyzes the current status of liver transplantation application, predictors of post-transplant mortality, recipient selection, and evidence for optimal timing, aiming to provide references for clinical decision-making.

Partial heart transplantation (PHT) refers to the procedure where fresh aortic or pulmonary valve as well as the associated root are procured from the donor heart and transplanted into children with congenital heart valve diseases. It is also known as allogeneic " living valve" transplantation or replacement. Compared with traditional mechanical or biological valves, the advantage of PHT lies in the fact that the transplanted valve tissue has the potential for growth and can grow synchronously with the development of the children. Moreover, the durability of the valve is good, and there is rarely any valve functional failure, thereby avoiding the risk of multiple surgical replacements required as the children grows. Although immunosuppressive treatment is still necessary after the operation, the required drug dosage is significantly lower than that of full heart transplantation, and the treatment time may be shorter, which helps children safely pass through critical growth periods. In recent years, the clinical feasibility, safety, and effectiveness of PHT have been gradually verified, bringing a paradigm shift to surgical treatment of congenital heart valve diseases. This article aims to systematically review the current clinical research progress in the field of PHT, including its surgical indications, techniques, efficacy and challenges.

Liver transplantation serves as a vital therapeutic modality for patients with end-stage liver disease and certain hepatic malignancies. Sarcopenia is a skeletal muscle disorder characterized by reduced muscle mass, diminished muscle strength, and impaired physical performance. In liver transplant candidates and recipients, sarcopenia is influenced by factors such as the catabolic effects of end-stage liver disease, malnutrition, surgical stress, immunosuppressive therapy, and postoperative metabolic reconstruction. Consequently, it constitutes a significant risk factor for perioperative complications, hospital readmissions, and compromised long-term rehabilitation outcomes. Standardized assessment, stratified management, and multimodal interventions for sarcopenia in the context of liver transplantation facilitate the identification of high-risk recipients and provide a foundation for perioperative rehabilitation management. Digital rehabilitation platforms can complement outpatient care by capturing data on physical activity and exercise adherence, thereby providing valuable support for continuous follow-up and functional monitoring. This article reviews the dynamic evolution, clinical assessment, and intervention strategies regarding sarcopenia in liver transplant recipients. It focuses specifically on the tripartite assessment framework-encompassing muscle strength, muscle mass, and physical performance-as well as the application of nutritional support, exercise rehabilitation, and pharmacologic adjuncts. Additionally, the article discusses the supportive value of digital rehabilitation platforms in continuous follow-up, functional monitoring, and the adjustment of rehabilitation regimens, while also delineating the current boundaries of the supporting evidence.