To enhance the clinical expertise in the diagnosis and treatment of invasive aspergillosis(IA)in kidney transplant recipients in China, the Branch of Organ Transplantation of Chinese Medical Association organized experts from both organ transplantation and infectious disease specialties.Drawing from existing clinical guidelines, systematic reviews, case studies and expert consensus, they synthesized and consolidated challenges encountered in the diagnosis and treatment of IA in kidney transplant recipients at home and abroad in recent years.Following multiple rounds of expert discussions that culminated in consensus, the Clinical diagnosis and treatment guideline for invasive aspergillosis in kidney transplant recipients in China were developed.This guideline encompasses 10 clinical questions and formulates 13 recommendations.Based on the 2009 Oxford University Center for Evidence-Based Medicine′s criteria for evidence grading and recommendation intensity, the strength of recommendations and the level of evidence for each clinical question were categorized.This guideline aims to enhance clinical practice and improve the long-term survival rate of kidney transplant recipients.

Organ transplantation is the standard treatment for end-stage organ failure, yet severe shortages of organs persist worldwide, necessitating the use of organs from extended criteria donor.Traditional static cold storage has limitations in evaluating organ function and mitigating ischemia-reperfusion injury.Consequently, various ex situ machine perfusion techniques have been developed, including hypothermic machine perfusion, hypothermic oxygenated perfusion, normothermic machine perfusion, ischemia-free liver transplantation, and sub-normothermic machine perfusion.Recent studies demonstrate that these technologies can extend preservation time, enable liver quality assessment, reduce ischemia-reperfusion injury, and improve transplantation prognosis.This guideline aims to promote the clinical application of ex situ liver machine perfusion in China.Based on evidencebased medicine principles and recent studies, recommendations are provided on graft procurement,preservation, quality evaluation, and transplantation prognosis.

Liver transplantation is the most effective treatment for end-stage liver diseases.Although the liver has a unique immunological microenvironment, resulting in significantly lower incidence and severity of rejection after liver transplantation than other solid organ transplantation,rejection remains common, with incidence of 15%-25%.Antithymocyte globulin (ATG) is a concentrated anti-human T-lymphocyte immunoglobulin preparation, which is used in the immunosuppressive induction therapy for the organ transplantation to improve the survival rate of graft and recipient.The Liver Transplantation Group, Branch of Organ Transplantation of Chinese Medical Association organized experts to discuss, summarize the latest progress of relevant research at home and abroad, and elaborate the mechanism, clinical application scenarios and precautions of ATG in combination with international guidelines and clinical practice, aiming to provide guidance and suggestions for clinical application of ATG in liver transplant recipients.

Sarcopenia is a group of systemic,progressive skeletal muscle diseases characterized by decreased muscle mass and muscle function due to a variety of etiological factors.The incidence of sarcopenia in liver transplant recipients in China exceeds 40%, which seriously restricts the efficacy of liver transplantation.To standardize and optimize the diagnosis and management of sarcopenia associated with liver transplantation, the Liver Transplantation Group, Branch of Organ Transplantation of Chinese Medical Association; Branch of Organ Transplant Physicians of Chinese Medical Doctor Association have organized experts to summarize and discuss the clinical diagnosis and management of sarcopenia associated with liver transplantation in China by combining the evidence-based medical basis and China's clinical practice experience, and by drawing on the relevant domestic and international literature.This guideline focuses on the diagnosis, assessment, clinical prevention and treatment of sarcopenia related to liver transplantation, and puts forward a series of recommendations in a scientific and standardized way, aiming at optimizing the perioperative and even mid-and long-term health management of liver transplantation in China.

Liver transplantation is an effective treatment for end-stage liver diseases, and an appropriate immunosuppressive regimen is fundamental to ensuring the long-term survival of both the graft and the recipient.Mycophenolic acid (MPA) derivatives are integral components of the basic immunosuppressive regimen for liver transplantation recipients.Mycophenolate sodium (MPS), the sodium salt of MPA, is used for the prevention of rejection in liver transplantation and the optimization of immunosuppressive protocols.The Liver Transplantation Group, Branch of Organ Transplantation of Chinese Medical Association, and Branch of Organ Transplant Physicians of Chinese Medical Doctor Association organized experts to summarize and discuss the mechanism, clinical applications, and considerations for the use of MPS in combination with international guidelines and clinical practice,aiming to provide guidance and suggestions for the clinical application of MPS in liver transplant recipients.

Sirolimus is a mammalian target of rapamycin inhibitor.Sirolimus is a frequently utilized immunosuppressant for liver transplant recipients, serving to both prevent rejection and inhibit tumor cell growth.In order to further standardize and optimize the application of sirolimus in liver transplant recipients for hepatocellular carcinoma in China, the Liver Transplantation Group,Branch of Organ Transplantation of Chinese Medical Association organized domestic experts to formulate the Chinese guideline for clinical application of sirolimus in liver transplant recipients with hepatocellular carcinoma (2024 edition) based on the Chinese expert consensus on application of sirolimus in liver transplantation for hepatocellular carcinoma (2020 edition), and fully drawing on relevant domestic and foreign literature and combining evidence-based medicine and China′s clinical practice experience,focusing on the clinical effects, application schemes, adverse reactions and drug monitoring principles of sirolimus in liver transplant recipients for hepatocellular carcinoma.

Organ transplantation is the most effective treatment for end-stage organ disease.One of the major challenges in organ transplantation is organ shortage.For this reason, more and more extended criteria donor organs including those from donation after circulatory determination of death(DCDD) are used in clinical practice.However, DCDD organs suffer from additional warm ischemic damage, which seriously affects transplant outcomes and organ utilization.Recent studies at home and abroad have shown that the application of normothermic regional perfusion (NRP) is able to improve the quality of organs and the success rate of transplantation.At present, an expert consensus on the clinical application of NRP in DCDD is lacking in China, which limits the standardization and high-quality development of DCDD in our country.We summarized the results of clinical studies and conducted in-depth discussions based on the principles of evidence-based medicine, to form this consensus on application of NRP in DCDD.This consensus focuses on the executive specification and corresponding research evidence of applying NRP technology in DCDD, aiming to provide reference opinions and guidance for the standardization of NRP in organ transplantation, and to promote the rapid development of NRP technology and DCDD organ transplantation in China.

Organ shortage is the biggest dilemma facing the development of organ transplantation.Deceased organ donation is an effective way to solve the dilemma, but there are still restrictive factors in organ donation in China.Only by developing the new quality productive forces of organ donation and transplantation can we solve the obstacles and problems affecting the development,and realize the improvement of the quantity and quality of organ donation.The discipline construction of organ procurement organization and the professional implementation of organ donation are the focus of the development of new quality productive forces.The innovative mechanism construction from the four aspects of publicity, reporting, evaluation and implementation can promote the establishment of a perfect organ donation system, so that organ donation and transplantation can be full of new vigor and vitality.Thus, the innovative construction and development of Chinese technology, Chinese standards,Chinese programs, Chinese teams, and Chinese discipline system from donation to transplantation will finally be realized.

Objective

To explore the current state of discharge readiness among caregivers of pediatric recipients following living related liver transplantation (LRLT) and to identify the influencing factors, thereby offering a reference for developing personalized discharge readiness services in clinical practice.

Methods

From September 2023 to February 2024, questionnaires were administered to 172 caregivers of pediatric LRLT recipients at the Department of Liver Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine.Data were collected using a general demographic questionnaire,the Chinese version of the Readiness for Hospital Discharge Scale-Parent Form (hereinafter RHDS),and the Chinese version of the Quality of Discharge Teaching Scale-Parent Form (hereinafter QDTS).Pearson correlation analysis was used to examine the relationship between discharge readiness and the quality of discharge teaching.Group comparisons were conducted with t-tests and one-way analysis of variance.Multiple stepwise linear regression was performed to identify the factors affecting discharge readiness among caregivers after LRLT.A P-value of <0.05 was considered statistically significant.

Results

A total of 161 valid questionnaires were returned, with an effective response rate of 93.6%.Among the 161 caregivers, 133(82.6%) believed that they were well-prepared for discharge, while 28(17.4%) felt unprepared.The total scores for the RHDS and QDTS in the 161 caregivers were(227.5±20.3) and (143.4±16.7), respectively, with corresponding average item scores of (7.8±0.7)and (8.0 ± 0.9).The RHDS scores for caregivers whose pediatric recipients had a postoperative hospitalization duration ≤16 d were (241.6 ±6.8), which were significantly higher than that for those with a hospitalization duration >16 d (212.1 ±19.0), with a statistically significant difference (t =12.901, P<0.05).Caregivers in married families had a higher RHDS total scores (228.0 ±19.9)compared to those in divorced families (187.0 ±2.8), with a statistically significant difference (t =2.902, P<0.05).There was a significant difference in RHDS total scores among caregivers with different monthly household incomes (F =4.974, P <0.05).The total scores of QDTS and its subdimension scores were positively correlated with the RHDS total scores and its sub-dimension scores (all P<0.05).Discharge guidance quality, postoperative hospitalization duration, family monthly income,and marital status were independent risk factors for discharge readiness among LRLT pediatric recipients′caregivers (all P <0.05).

Conclusions

The discharge readiness of caregivers of pediatric recipients after LRLT is at a moderate level.Healthcare providers should pay attention to caregivers with low discharge guidance quality, long postoperative hospitalization, low family income, and divorced marital status, and provide targeted discharge guidance interventions to improve their discharge readiness.

Hepatoblastoma (HB) is the most common type of malignant liver tumor in children.Adjuvant chemotherapy and neoadjuvant chemotherapy can significantly increase the survival rate of children with HB.But for locally advanced or refractory HB, liver transplantation is one of the key treatment strategies.This article delves into the population of children with HB, offering an indepth review of the clinical symptoms,diagnosis,treatment,and nursing care involved in managing this condition.It specifically highlights the importance of nursing measures following HB resection and chemotherapy, as well as the key nursing considerations for children with HB after undergoing liver transplantation.The article also underscores the significance of postoperative nursing quality control standards, perioperative nursing protocols, proper management of immunosuppressive agents, and thorough follow-up care.By outlining these essential elements, this article aims to provide valuable insights for the establishment of standardized nursing practices for children with HB after liver transplantation in China.