Kidney injury is a common complication after liver transplantation, including acute kidney injury and chronic kidney disease. Kidney injury in liver transplant recipients seriously affects their long-term survival and life quality, and is one of the main causes of death after liver transplantation. In order to standardize and optimize the diagnosis and treatment of kidney injury in liver transplant recipients, Branch of Organ Transplant of Chinese Medical Association and Branch of Organ Transplant Physicians of Chinese Medical Doctor Association organize experts to develop the "Clinical Practice Guidelines for Kidney Injury Management of Liver Transplant Recipients in China (2023 Edition)" to adapt to the rapid development of diagnosis and treatment. The guideline is based on "Chinese expert consensus on management of kidney injury in liver transplant recipients (2017 edition)" and in conjunction with recent evidence-based medicine and clinical practice experience in China. This guideline focuses on the definition, classification, assessment and preoperative, intraoperative and postoperative prevention and treatment of kidney injury in liver transplant recipients. By presenting a series of scientifically standardized recommendations, the guideline is aimed to optimize the management of kidney injury in liver transplant recipients in China.

China′s organ donation and transplantation has made significant progress through decades of arduous exploration, combined with multiple supportive factors such as people′s health needs, national leadership, social support and hard efforts. In recent years, China has successively introduced relevant laws and regulations to establish a legal framework for organ donation and transplantation at the national level. Recently, the "Regulations on Human Organ Transplantation" have been revised for the first time in 16 years, improving the relevant content of "organ donation" , which will better ensure the healthy development of organ donation and transplantation. In line with the development trend, organ donation has become a new discipline jointly created by multiple disciplines in China′s new era. Promoting the construction of an organ donation discipline system with the overall goal of safeguarding the legitimate and reasonable rights and interests of organ donors and their families, as well as the health rights and interests of transplant recipients, is in line with the fundamental requirements of promoting the high-quality development of organ donation and transplantation in China. This article analyzes the current development status of organ donation worldwide and in China in recent years, and demonstrates the necessity and feasibility of building an organ donation discipline system based on interdisciplinary integration.

In January 2015, organ donation after citizens′ death has become the only legal source of organs in China. After 8 years of reform practice and 2 years of special rectification, organ donation and transplantation in our country show fast, leap-forward development on a legal, ethical, scientific and standardized road, and has shown a good trend of high-quality, healthy and sustainable development along the same track as the international community. At present, China′s organ donation and transplantation ranks first in Asia and second in the world, which has been highly praised and supported by the international transplant community. However, the huge quantitative difference between donors and recipients is still a realistic problem that organ transplant doctors have to face. The development of xenotransplantation may be an effective means to alleviate the current situation of organ shortage, and its clinical promotion needs to overcome the serious complications caused by cross-species genetic differences. This paper summarizes the current development status of organ donation and transplantation in China and the progress of clinical research on xenotransplantation.

肺炎克雷伯菌(Klebsiella pneumoniae，KP)因其在医院内积累多重耐药性，以及导致严重社区相关性感染的风险，已成为一种威胁人类健康的致病菌^[1]。KP通常存在于鼻腔、咽喉、皮肤和肠道菌群中，可引起肺炎、败血症以及软组织、手术伤口和泌尿道等一系列感染，尤其当人体处于免疫抑制状态时^[2,3]。碳青霉烯类药物是肠杆菌科产广谱β内酰胺酶和头孢菌素酶菌株引起严重感染的一线治疗药物^[4]，随着其在临床广泛应用，耐碳青霉烯类肠杆菌科细菌检出率逐年上升，其中耐碳青霉烯类肺炎克雷伯菌(carbapenem-resistant Klebsiella pneumoniae，CRKP)增长尤其显著。CRKP因其条件致病及多重耐药性，易感染长期使用广谱抗菌药物和免疫抑制剂的肾移植受者^[5]。本研究回顾性分析近年来武汉大学人民医院器官移植科收治的肾移植术后CRKP感染病例，旨在探讨肾移植术后CRKP感染的防治措施。

China attaches great importance to the development of organ donation and transplantation. Since 2015, when China comprehensively carried out the work of human organ donation, the number of human organ donations in China has steadily increased. However, organ donation in China is still in its infancy, learning from the system advantages of "excellent donation countries" such as the United States and Spain, and vigorously developing human organ donation and procurement is the foundation for the vigorous development of human organ donation and transplantation. Among them, the "U.S. model" consists of the United Network for Organ Sharing (UNOS), human Organ Procurement Organizations (OPO) and transplantation hospitals, which are closely connected and together constitute the U. S. donation and transplantation system. Its core features include that UNOS manages the only U. S. organ procurement and transplantation network, formulates and revises allocation policies, and OPO is independent of transplantation hospitals, and UNOS provides tools, resources and expertise to help OPO improve the quality of their services. The core features of the "Spanish model" are its three-tiered management structure, close relationship with the media, specialized coordinators in the hospitals, and an intensive training program tailored to all personnel. Learning from the U. S. and Spain′s human organ donation and transplantation management models and applying them to China′s organ donation according to local conditions, we can further improve the system and form a "China model" that is favorable to China′s organ donation and transplantation.

肝移植是治疗终末期肝病最有效的方法。随着外科技术和免疫抑制药物的发展，肝移植受者和移植物生存率已显著提高。根据中国肝移植注册中心(China Liver Transplant Registry，CLTR)数据，2015至2021年我国共实施肝移植35 566例，公民逝世后器官捐献肝移植和活体肝移植受者术后1、3、5年生存率分别为83.7%、74.5%、68.9%和92.4%、89.3%、88.2%^[1]。肝移植受者的长期存活和生存质量很大程度上取决于术后中长期健康管理和免疫抑制方案。长期服用免疫抑制剂可导致受者出现肾损伤、代谢性疾病和新发恶性肿瘤等严重并发症，甚至增加肝癌肝移植术后肿瘤复发风险^[2]。目前肝移植受者常用的免疫抑制方案以钙调磷酸酶抑制剂(calcineurin inhibition，CNI)为基础，其中以他克莫司+吗替麦考酚酯(mycophenolate mofetil，MMF)+泼尼松方案最为普遍。但是CNI引起的肾脏毒性、神经毒性和促进肿瘤复发等问题极大地影响了受者预后，近年来临床逐渐减少其用量并寻求替代药物。

In recent years, organ transplantation in our country has witnessed significant growth. However, rejection reactions remain the primary complications affecting graft function and survival rates. Long-term immunosuppressive therapy is the most effective method for preventing rejection reactions. Nevertheless, currently used immunosuppressive agents such as mycophenolate mofetil have notable side effects, leading to many patients being unable to tolerate these side effects, thereby necessitating dose reduction or discontinuation. This, in turn, increases the risk of rejection reactions, ultimately resulting in graft failure. Mizoribine is an immunosuppressant that can concurrently inhibit the proliferation and differentiation of both T lymphocytes and B lymphocytes, with relatively fewer side effects. In recent years, it has been widely employed in the maintenance immunosuppressive therapy following kidney, liver, and other organ transplantations. Although Mizoribine has not yet been applied in the lung transplantation, clinical research evidence from the liver and kidney transplantation present some indications for its application in the lung transplantation, which is worthy of clinical attention and further research.

肾移植术后免疫抑制强度的增加，使受者对各类病原体表现出高度临床易感性。在实体器官移植领域，国内外仅有肝移植术后华支睾吸虫感染相关案例报道，且多为供者来源性感染(donor-derived infection，DDI)^[1]。目前，基于宏基因组高通量测序(metagenomic next generation sequencing，mNGS)技术的广谱病原微生物筛查已逐渐应用于临床感染的辅助诊断。本研究通过回顾性分析南方医科大学南方医院1例应用mNGS辅助诊断的肾移植术后华支睾吸虫感染患者临床资料，分析其临床特点和治疗经验，为肾移植术后寄生虫感染的早期诊断与防治提供经验。

To enhance clinical physicians′ understanding of the use of mycophenolic acid in liver and kidney transplant recipients, further standardize the clinical use of mycophenolic acid, and establish basic principles for the switch of mycophenolic acids of different brands and formulations in clinical practice.This consensus, grounded in both evidence and clinical experience, has been collaboratively developed by the Branch of Organ Transplant of Chinese Medical Association, Branch of Organ Transplant Physicians of Chinese Medical Doctor Association, and the Shanghai Pharmaceutical Profession Association.The overarching hope is that this document will serve as a foundational reference for the clinical application of mycophenolic acids in liver and kidney transplant scenarios.

The organ transplantation system in the United States has experienced significant growth over the years, with an increasing number of organ donations and transplants. However, institutions involved in organ transplantation are continuously identifying and addressing issues within the system, aiming to propose targeted solutions and improvement goals. In 2022, the National Institutes of Health of United States released a research report titled "Realizing the Promise of Equity in the Organ Transplant System" (referred to as the research report), providing guidance for the development of the organ transplantation system in the United States in the next five years. Although the research report focuses on the situation in the United States, its recommendations for improving the organ transplantation system hold valuable insights. This article presents a concise analysis of the fairness and efficiency issues within the organ transplantation system in the United States, and emphasizes the recommendations provided in the research report to improve fairness, efficiency, and organ utilization. Furthermore, the article explores the potential application of these insights in enhancing the organ donation and transplantation system in China, to promote the high-quality development of organ donation and transplantation in our country.

呃逆是指横膈膜和肋间肌的突然不自主、间歇性、痉挛性收缩，导致声门突然关闭，发出特征性的"嗝"声。呃逆大多数是急性发作、有自限性的良性疾病，持续性呃逆和顽固性呃逆分别指持续48 h以上和1个月以上的呃逆。实际上，呃逆持续大于24 h即可被认为是难治性的^[1]。顽固性呃逆的病理生理学机制尚不完全清楚，目前认为与呃逆反射弧相关的神经损伤、刺激或炎症有关。导致难治性呃逆的原因包括胃肠道疾病、代谢异常、迷走神经刺激、中枢神经系统疾病、某些药物以及涉及胃或膈肌的手术。然而，在许多情况下，难治性呃逆对临床医师是一个不可预知的挑战，难以找出确切病因。持续性呃逆会导致患者疲惫、睡眠不足、焦虑和体质量下降等，严重影响生活质量^[2]。本研究总结苏州大学附属第一医院血液科1例骨髓增生异常综合征(myelodysplastic syndrome，MDS)患者在异基因造血干细胞移植(allogeneic hematopoietic stem cell transplantation，allo-HSCT)过程中并发难治性呃逆的诊治过程，现报道如下。

Post-transplant diabetes mellitus (PTDM) is a common endocrine and metabolic disorder after adult solid organ transplant (SOT), affecting 10% to 40% of recipients. PTDM has been associated with increased mortality, heightened risk of infections, graft-related complications and cardiovascular diseases, all of which seriously threaten the quality of life and long-term survival of recipients. According to recent studies and the domestic healthcare system, this consensus provides a comprehensive overview of the epidemiology, risk factors, pathogenesis, screening and diagnosis, treatments, prevention strategies, cardiovascular risk factor management and microvascular complications associated with PTDM, in order to further standardize the diagnosis and treatment of PTDM. The objective is to standardize the comprehensive management of PTDM with the aim of enhancing the long-term quality of life and clinical outcomes for SOT recipients.

With the continuous progress of renal transplantation technology, the survival rate of patients with end-stage renal disease has been increasing, and at the same time, it has brought about many changes and challenges. The past year has opened a whole new chapter in organ transplantation worldwide. This article summarizes the major advances in allogeneic kidney transplantation, expanding donor sources and surgery, graft rejection, immunologic tolerance, and the progress and significance of regenerative medicine in 2023.

The liver and gut can have bidirectional effects through the gut-liver axis. The gut barrier in a normal human can limit the filtration of gut bacteria, macromolecular antigens, and endotoxins. However, for liver transplantation recipients, ischemia-reperfusion injury and early functional impairment of the donor liver will weaken the inhibition of bile acids on gut microbiota. Gut congestion can cause the accumulation of inflammatory factors, produce a large amount of oxygen free radicals, disrupt the gut barrier, and promote the translocation of gut microbiota through the gut liver axis. The imbalance of gut microbiota can have multiple impacts on the donor liver and increase the risk of perioperative infection, acute rejection, and biliary complications. In the future, by further exploring the new mechanisms of the impact of gut microbiota on perioperative complications of liver transplantation, detection and intervention of the occurrence and development of complications, we will effectively reduce the perioperative mortality rate of patients, improve long-term prognosis, and bring positive effects to the development of liver transplantation.

鲍恩样丘疹病(bowenoid papulosis，BP)是一种较少见的外阴疾病，多发生在性活跃人群，与高危型人乳头瘤病毒(human papilloma virus，HPV)16、18感染密切相关^[1]。BP是一种皮肤癌前病变，免疫抑制人群更易患此病。大部分BP患者预后良好，部分病例可自行消退，但有低于1.0%的比例可转化为肿瘤，尤其是伴高危型HPV 16、18阳性者及免疫功能缺陷者可能会发展为浸润性鳞状细胞癌，因此器官移植后BP患者应尽早治疗^[2,3]。BP可采用外用药物、激光、冷冻和手术等多种治疗方法，但多只针对可见病变治疗，不能完全清除潜伏或无症状感染的HPV病灶，导致BP复发率较高^[4]。复发病例经多次治疗后，也可能因刺激产生不典型增生，加速皮损恶变可能。光动力疗法(photodynamic therapy，PDT)由于其良好的组织选择性及安全性，被越来越广泛应用于原位宫颈鳞状细胞癌、尖锐湿疣和BP等治疗，且复发率较低^[5,6,7,8]。本文回顾性分析浙江大学医学院附属第一医院1例肾移植后BP患者行激光联合PDT治疗的临床资料，总结诊治经验，现报道如下。