Median arcuate ligament compression syndrome (MALS) presents with atypical clinical manifestations. MALS is rarely reported in pediatric patients but is recognized as an independent risk factor for postoperative hepatic artery thrombosis in liver transplant recipients. We report a case of a pediatric liver transplant recipient with hepatolenticular degeneration, cirrhosis, and acute liver failure. Despite undergoing artificial liver support therapy, the patient showed no significant improvement in liver function and subsequently underwent liver transplantation. Intraoperatively, weak arterial pulsation and the absence of a pulsatile waveform in the hepatic artery anastomosis raised suspicion of MALS. The condition was successfully managed by releasing and transecting the median arcuate ligament, along with ligation of the splenic and left gastric arteries. To optimize transplantation outcomes, meticulous preoperative imaging assessment, particularly focusing on characteristic findings in CT angiography, is essential. Additionally, individualized surgical planning and intraoperative adjustments based on ultrasound monitoring and arterial pulsation assessments are critical for ensuring successful transplantation.

Objective:To investigate the predictive value of elevated calprotectin S100A9 (S100A9) concentration during living-donor liver transplantation (LDLT) for early acute lung injury (ALI) in children with biliary atresia.Method:A retrospective analysis was conducted on 280 pediatric patients with biliary atresia who underwent LDLT using hyperreduced left lateral segment grafts at Tianjin First Central Hospital between January 2019 and January 2021. Based on intraoperative serum S100A9 levels at 30 minutes after graft reperfusion, patients were divided into the high S100A9 group (≥9.05 μg/L, 141 cases) and the low S100A9 group (<9.05 μg/L, 139 cases). General clinical characteristics were compared between the two groups. Univariate and multivariate logistic regression analyses were performed to examine the correlation between S100A9 levels and early postoperative ALI. The predictive value of risk factors was assessed using receiver operating characteristic (ROC) curve analysis with calculation of the area under the curve (AUC) .Result:A total of 280 eligible children were included in the study, with 141 in the high S100A9 group and 139 in the low S100A9 group. The incidence of ALI was significantly higher in the high S100A9 group (31.2%) compared to the low S100A9 group (10.8%). Multivariate regression analysis identified elevated preoperative creatinine levels ( OR=1.191, 95% CI: 1.069~1.321, P=0.002), increased intraoperative S100A9 concentrations ( OR=1.426, 95% CI: 1.272~1.599, P=0.021), and higher intraoperative blood transfusion volume ( OR=0.985, 95% CI: 0.973~0.997, P=0.017) as independent risk factors for postoperative ALI in pediatric LDLT. The predictive value of intraoperative S100A9 levels for ALI was significant, with an AUC of 0.816 (95% CI: 0.758~0.874), a sensitivity of 80.5%, a specificity of 73.7%, and an optimal cutoff value of 9.49 μg/L. Furthermore, preoperative albumin and creatinine levels were found to be correlated with increased intraoperative S100A9 levels. Conclusion:Elevated intraoperative S100A9 levels, increased preoperative creatinine levels, and higher intraoperative blood transfusion volumes are independent risk factors for early ALI following pediatric LDLT. S100A9 levels have strong predictive value for ALI occurrence, highlighting the need for perioperative monitoring and intervention strategies to improve postoperative outcomes.

Objective:To investigate the treatment approaches and outcomes of early hepatic artery thrombosis (E-HAT) in adult recipients following orthotopic liver transplantation (OLT).Methods:A retrospective analysis was conducted on clinical data of E-HAT cases after adult OLT at the First Affiliated Hospital of Xi'an Jiaotong University from January 2010 to June 2022. Clinical characteristics, treatment methods, therapeutic outcomes, long-term survival of recipients and grafts, and the incidence of long-term complications were summarized. The Kaplan-Meier method was utilized to calculate recipient survival rates.Results:Among 1 016 OLT recipients, 22 cases (2.2%) developed postoperative E-HAT. There were 19 males and 3 females, with a age of 44.81±9.98 years. E-HAT was diagnosed via angiography at a median of 3.5 (1.0, 7.0) days post-OLT. Twenty recipients underwent vascular intervention therapy, achieving clinical success in 14 cases (70.0%) with a mean thrombolysis duration of 5.1±3.2 days. Twelve cases (60.0%) experienced complications, including abdominal bleeding (10 cases), gastrointestinal bleeding (1 case), catheter-related infection (1 case), subcutaneous bleeding (1 case), and hepatic artery dissection (1 case). Five recipients underwent hepatic artery re-anastomosis, including two initial cases and three following failed interventional therapy. Surgery was performed at a median of 5.0 (1.0, 15.3) days post OLT, with 4 successful cases. Through combined interventional and surgical treatment, 81.8% (18/22) of grafts were salvaged. However, the success rate was significantly lower in cases with marked transaminase (AST, ALT) and total bilirubin elevation (16/18 vs 2/4). Nineteen E-HAT survivors were followed for a median of 22 (5, 52) months. During follow-up, 2 cases experienced thrombus recurrence, and 12 cases developed biliary complications, including ischemic biliary stenosis (11 cases), extensive liver necrosis (1 case), localized liver abscess (1 case), and biliary anastomotic stenosis (1 case). Seven recipients died due to graft failure. The 1-year, 3-year and 5-year cumulative survival rates were 67.2%, 60.5% and 34.5%, respectively.Conclusions:Combined interventional and surgical treatment demonstrates a high success rate for managing E-HAT, particularly when addressed before significant graft damage. Ischemic biliary stenosis remains the most common long-term complication.

Objective:To investigate the current application status of prophylactic anti-infective drugs during the perioperative period in liver transplantation centers and provide data references for further standardizing prophylactic regimens.Methods:A questionnaire comprising 53 questions across 5 dimensions was designed and released using the WJX platform. The dimensions included basic information about medical institutions, perioperative pathogenic microorganisms, current status of empirical antibacterial prophylaxis, adjustments to prophylactic anti-infective strategies, and an overview of prophylactic measures against other pathogens. Based on the survey results, the types of common perioperative pathogens in liver transplantation, types of prophylactic antibacterial drugs, timing and duration of administration, upgraded prophylaxis strategies (such as escalation of antibiotic classes or extension of drug application duration), and prevention strategies for other pathogens were summarized.Results:A total of 13 completed questionnaires from pharmacists at liver transplantation centers were collected. The most common pathogens during the perioperative period were Gram-negative bacilli, including Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, and Acinetobacter baumannii. The most frequently used prophylactic antibacterial drugs were cefoperazone/sulbactam and piperacillin/tazobactam. Regarding the timing of administration, 9 centers administered drugs 0.5 to 1.0 hour before surgery, 3 within 0.5 hour, and 1 within 1 hour preoperatively. The prophylactic duration was within 7 days postoperatively for living donor liver transplantation in 10 centers, while for cadaveric donor liver transplantation, only 6 centers adhered to the 7-day duration. When donors had infections with sensitive bacteria, 9 centers upgraded prevention strategies: 2 centers escalated the antibiotic class or adjusted regimens, 5 centers extended the duration of prophylaxis, 2 centers implemented donor-specific susceptibility-guided antibacterial treatments regardless of colonization or infection, and 5 centers administered prophylaxis only in cases of colonization based on donor susceptibility results. When donors had multi-drug resistance bacterial infections, 11 centers upgraded prevention strategies: 7 escalated the antibiotic class or adjusted regimens, 4 extended prophylaxis duration, 6 implemented susceptibility-guided treatments irrespective of colonization or infection, 1 administered prophylaxis only for colonization based on donor susceptibility results, and 2 abandoned transplantations. 7 centers routinely applied antifungal prophylactic measures, including 1 for preoperative prophylaxis and 6 for postoperative prophylaxis, using caspofungin (4 centers), fluconazole (2 centers), posaconazole (1 center), and micafungin (1 center). 6 centers initiated antifungal prophylaxis in cases with donor or recipient fungal infection history or active fungal infections detected during liver procurement. Most antifungal prophylaxis was administered within 72 hours postoperative (11 centers), with durations mostly within 14 days (12 centers). For viral infections, 6 centers adopted routine postoperative prophylactic measures. Conclusions:Currently, the perioperative prophylactic anti-infective strategies in 13 liver transplantation centers are not standardized. High-quality multicenter clinical studies are needed to compare the effectiveness of different prophylactic regimens, aiming to further standardize the types and durations of prophylactic drug use.

This article reports the diagnosis and treatment of two cases of complex ureteral obstruction (UO) in transplanted kidneys managed at Tangdu Hospital of Air Force Medical University of PLA in 2023. UO is a challenging complication following kidney transplantation, with surgical repair being the primary treatment approach. Both patients underwent robot-assisted laparoscopic (RAL) anastomosis of the transplanted kidney collecting system with the autologous ureter. The procedures were successfully performed, and both recipients were discharged without complications. During a six-month postoperative follow-up, the morphology and function of the transplanted kidneys remained stable, with no recurrence of hydronephrosis, fever, pain, urinary frequency, or urgency. This case report provides new insights into the diagnosis and surgical management of complex UO in kidney transplant recipients.

This study reports the diagnosis and treatment of six cases of post-transplant lymphoproliferative disorder (PTLD) in liver transplant recipients, confirmed at the Affiliated Hospital of Qingdao University between August 2017 and May 2023. The report includes details on anti-rejection therapy, Epstein-Barr virus (EBV) and cytomegalovirus (CMV) infections, imaging findings, histopathological results, treatment courses, and prognoses. By summarizing the clinical experience in the diagnosis and management of PTLD following liver transplantation, this study aims to provide valuable insights and references for the clinical diagnosis and treatment of this condition.

Tuberculosis remains one of the most lethal infectious diseases, posing a significant threat to global public health. Kidney transplant recipients have a higher incidence of latent tuberculosis infection (LTBI) than the general population, which adversely affects transplant outcomes. Early screening and prophylactic treatment are essential in reducing the risk of LTBI reactivation. This review summarizes recent advances in the epidemiology, screening and diagnostic methods, and preventive strategies for LTBI in kidney transplant recipients, providing valuable insights and references for its prevention and management in this high-risk population.

Lung transplantation is a key therapeutic approach for patients with end-stage lung diseases. Although its clinical outcomes have significantly improved, multidimensional injuries sustained by donor lungs during procurement, preservation, and transplantation remain major challenges affecting graft survival and long-term prognosis. This article proposes the "Guangzhou Classification" for full-course management of donor lung injury, characterized by spatiotemporal dynamics. Based on the progression of disease stages, donor lung injuries are systematically divided into three types: primary injuries (including donor ICU-related lung injury, pathogen colonization, and cold ischemia injury), secondary injuries (such as ventilator-induced lung injury after transplantation, ischemia-reperfusion inflammatory storm, and early rejection), and accompanying injuries (organ toxicity caused by accumulation of postoperative sedatives, analgesics, and vasoactive drugs). Drawing on previous studies and the clinical experience of our center, this paper elaborates the temporal evolution, key risk factors, and prevention and treatment strategies of each injury category, and discusses future research directions. By targeting critical injury factors at each stage, this classification aims to optimize both short-term and long-term outcomes of lung transplantation.

Objective:To summarize and investigate the ultrasound manifestations, clinical characteristics, causes, and prognosis of hepatic portal vein gas (HPVG) after liver transplantation in children.Methods:A case series study. Clinical data of 9 pediatric recipients diagnosed with HPVG by ultrasound after liver transplantation between January 2012 and August 2023 were collected, and the ultrasound manifestations, causes, clinical features, and prognosis of HPVG were analyzed.Results:A total of 1,850 pediatric liver transplantations were performed during the same period in Tianjin First Central Hospital, among which 9 cases (0.48%) developed HPVG; 6 cases occurred within 1 month after surgery, and 3 cases occurred more than 1 month after surgery; the duration ranged from 2 to 15 days, with a median of 7 (4.5, 9.0) days. HPVG was first detected by ultrasound in all cases, with common ultrasound manifestations including bubble-like or punctate strong echoes flowing with blood in the portal vein, and patchy strong echoes with unclear borders in the liver parenchyma. Among the 9 patients, 3 had diarrhea with intestinal flora imbalance, 2 had abdominal distension with incomplete intestinal obstruction, 1 had colonic fistula with repeated replacement of Li's tube and concurrent abdominal distension, 1 was experiencing acute T-cell-mediated rejection of the transplanted liver, and the remaining 2 were asymptomatic. Patients with diarrhea and intestinal dysbiosis were treated with Bifidobacterium Lactobacillus triple viable tablets to regulate flora and montmorillonite powder to relieve diarrhea, which gradually subsided. Patients with abdominal distension and incomplete intestinal obstruction were treated with fasting, intravenous nutrition, and enema, and the obstruction gradually resolved, along with disappearance of HPVG.Conclusion:HPVG after liver transplantation has characteristic ultrasound manifestations, and its occurrence may be related to intestinal gas, obstruction, dysbiosis, or mucosal damage. Treatment may be conservative or surgical depending on the underlying cause and severity.

Objective:To investigate the risk factors for early allograft dysfunction (EAD) following deceased donor liver transplantation in pediatric recipients.Method:A retrospective analysis was conducted on 390 pediatric liver transplant recipients who underwent deceased donor liver transplantation at Tianjin First Central Hospital between January 1, 2018, and December 31, 2023. Patients were categorized into the EAD group (152 cases) and the non-EAD group (238 cases) based on the presence or absence of EAD. Patient and graft survival rates were compared between the two groups. Multivariate logistic regression analysis was performed to identify independent risk factors for EAD. A nomogram was constructed and validated using receiver operating characteristic (ROC) curves to assess predictive performance.Result:Among the 390 pediatric liver transplant recipients, 152 cases (38.97%) developed EAD. Postoperative intensive care unit (ICU) stay and duration of ventilatory support were significantly longer in the EAD group compared to the non-EAD group ( P<0.05). The 1-month (90.8% vs. 97.1%) and 3-month (90.7% vs. 95.4%) cumulative graft survival rates were significantly lower in the EAD group than in the non-EAD group ( χ2=4.36, P=0.037). However, the 1-month (93.4% vs. 97.9%) and 3-month (92.8% vs. 96.6%) cumulative recipient survival rates showed no statistically significant difference between the two groups ( χ2=3.15, P=0.076). Multivariate logistic regression analysis identified recipient weight ( P=0.0091), preoperative blood lactate level ( P=0.0065), donor age ( P=0.0434), operative duration ( P<0.01), cold ischemia time ( P<0.01), and portal venous flow (PVF) before abdominal closure ( P=0.0241) as independent risk factors for EAD. The combination of these factors demonstrated good predictive performance for EAD, with an area under the curve (AUC) of 0.75 (95% CI: 0.70~0.80, P<0.05) . Conclusion:Recipient weight, preoperative blood lactate levels, donor age, operative duration, cold ischemia time, and PVF before abdominal closure are significantly associated with the development of EAD in pediatric recipients undergoing deceased donor liver transplantation. Optimizing preoperative donor and recipient assessment, as well as refining surgical procedures, may help reduce the incidence of EAD and improve post-transplant outcomes.