As proposed in 2019 Annual Congress of the Chinese Society of Organ Transplantation, the overall objective of the development of organ transplantation in China is to deepen the structural reform of the supply side comprehensively, to promote the transition of organ transplantation from the quantitative scale model to the quality-lifting type, and to promote the scientific, balanced, standardized and high-quality development of organ transplantation. This paper introduces the construction of quality management system and the implementation of quality improvement program in the field of surgery and transplantation in the United States, summarizes the preliminary work of how to combine foreign experience to promote the construction of quality improvement program of renal transplantation in our country, and proposes the idea of extending the quality improvement program of organ transplantation.

The induction of immune tolerance is an essential component and the utmost goal in the field of organ transplantation immunity, which depends upon the recognition and presentation of transplantation antigens, the activation and response of the immune system and other immune essence. However, before successfully inducing immune tolerance, how to carry out individualized induction of immune tolerance in organ transplant recipients to optimize the combination of immunosuppressive agents and individualized treatment and achieve the ideal state of optimal prevention and treatment of immune rejection and minimal adverse reactions, remains to be further resolved by the organ transplantation practitioners. Based on the reports of international core journals, the individualized induction strategy of immune tolerance and the future prospects were reviewed in this article from the following aspects including the mechanism underlying induction of immune tolerance, realization of operational immune tolerance, novel strategy of individualized induction of immune tolerance and application of regulatory T cell in individualized immune tolerance in combination with clinical and laboratory research results of regulatory T cell in our center.

Enhanced recovery after surgery (ERAS) refers to adopting a series of perioperative optimization measures to prevent or reduce the inflammatory stress response, promote rapid postoperative recovery of patients, shorten the length of hospital stay, reduce the incidence of postoperative complications, readmission rate and mortality rate. As the only effective treatment for end-stage liver disease, liver transplantation is characterized with difficult operation, long operation time, large amount of blood transfusion during operation and complicated postoperative management, etc. Postoperative recovery of liver transplantation is facing great challenges. In this article, research progresses on the application of ERAS in the perioperative period of liver transplantation and the suggestions for the implementation of ERAS during this period were introduced.

The 25th Annual Congress of International Liver Transplantation Society (ILTS) was held from May 15 to 18, 2019 in Toronto, Canada. Focusing on the special topic of liver transplantation for liver cancer, down-staging liver cancer and bridging therapy before liver transplantation, prediction of liver cancer recurrence after liver transplantation, individualized immunosuppressive scheme, prevention and treatment of liver cancer recurrence after liver transplantation were summarized in this article. In addition, the literatures published in recent two years related to the research progress were reviewed.

Objective To explore the effect and mechanism of Yes-associated protein (YAP) in hepatic ischemia-reperfusion injury (IRI) of mice. Methods Forty male C57BL/6 mice were randomly divided into the sham operation group (Sham group), lysophosphatidic acid (LPA) + Sham group, IRI group and LPA+IRI group, 10 mice in each group. Liver tissue and serum samples were collected at 6 h after ischemia-reperfusion. The levels of serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were detected. Histopathological changes and macrophage infiltration of liver tissues were detected by hematoxylin-eosin (HE) staining and immunohistochemical staining. The protein expression level of YAP was detected by Western blot. The messenger ribonucleic acid (mRNA) expression levels of inflammatory cytokines including tumor necrosis factor (TNF)-α, inducible nitric oxide synthase (iNOS), interleukin (IL)-1 and IL-6 were quantitatively measured by reverse transcription polymerase chain reaction (RT-PCR). Results Western blot results demonstrated that the protein expression level of YAP in the LPA+IRI group was significantly up-regulated than that in the IRI group. Compared with the Sham group, the ALT and AST were significantly higher in the IRI group (both P < 0.05). The serum levels of ALT and AST in the LPA+IRI group were significantly lower than those in the IRI group (both P < 0.05). HE staining revealed that the morphology of hepatocytes was normal in the Sham group and LPA + Sham group. Pathological changes, such as liver congestion, liver cell swelling and structural abnormalities of hepatic lobule, occurred in the LPA+IRI group and IRI group. Compared with the IRI group, pathological changes were alleviated in the LPA+IRI group. RT-PCR indicated that the mRNA expression levels of TNF-α, iNOS, IL-1 and IL-6 in the LPA+IRI group were lower than those in the IRI group (all P < 0.05). Immunohistochemical demonstrated that LPA partially inhibited macrophage infiltration in ischemic tissues after IRI. Conclusions YAP can significantly mitigate hepatic IRI. The mechanism is associated with the regulation of macrophage recruitment and activation.

Objective To investigate the effect and mechanism of interleukin (IL)-17C in mice undergoing kidney transplantation. Methods The life-supporting kidney transplantation mice models were established using Balb/c (H-2K^d) mice as the donors, IL-17C gene knock out (IL-17CKO) mice (knockout group) and C57BL/6J(H-2K^b) mice (wild group) were chosen as the recipients. The postoperative body mass and survival time of mice were statistically compared between two groups. Pathological examination of the kidney graft was performed by using hematoxylin-eosin (HE) staining and periodic acid-Schiff (PAS) staining. The expression levels of granzyme B, interferon (IFN)-γ, tumor necrosis factor (TNF)-α, IL-6 and IL-1β messenger ribonucleic acid (mRNA) in the kidney graft tissue were quantitatively measured by reverse transcription polymerase chain reaction (RT-PCR). The proportion of inflammatory cell infiltration in the kidney graft tissue was detected by flow cytometry. Results In the knockout group, the survival time of mice after kidney transplantation was significantly shorter than that of the wild mice (P=0.031). The body mass was more evidently decreased in the knockout group with no statistical significance from that in the wild group. Pathological examination demonstrated that the kidney graft injury in the knockout group was significantly worse than that in the wild group. The mRNA expression levels of granzyme B, IFN-γ, TNF-α, IL-6 mRNA in the knockout group were significantly up-regulated compared with those in the wild group (all P < 0.01). The mRNA expression level of IL-1β showed a decreasing trend with no statistical significance (P=0.16). Flow cytometry analysis revealed that the infiltration of CD45⁺CD11b⁺Ly6G⁺ neutrophil and CD45⁺CD11b⁺Ly6C^hi monocyte in the kidney graft of knockout mice was significantly higher compared with that of the wild mice (P < 0.05, P < 0.01), whereas the infiltration of CD45⁺Ly6C^hiF4/80⁺ macrophage did not significantly differ between two groups (P > 0.05). Conclusions IL-17C participates in the regulation of inflammatory response after kidney transplantation. It can alleviate acute rejection and improve the survival of kidney graft by down-regulating the expression of pro-inflammatory cytokines and infiltration of inflammatory cells.

Objective To investigate the rationality and efficacy of enhanced recovery after surgery (ERAS) in liver transplant recipients. Methods Clinical data of 465 liver transplant recipients were retrospectively analyzed. All recipients were divided into the ERAS group (n=163) and control group (n=302) according to whether they received ERAS. The severity of disease in the ERAS group was worse than that in the control group. Operation situations including the operation time, anhepatic phase and intraoperative blood transfusion volume of the liver transplant recipients were observed and recorded. Postoperative recovery conditions including the length of intensive care unit (ICU) stay, total length of hospital stay, total ventilator removal time at postoperative 28 d and postoperative re-intubation rate were recorded. The survival rates at 90 d, 180 d and 1 year after liver transplantation were calculated. The influencing factors of survival rate of liver transplant recipients were analyzed. Results The anhepatic phase in the ERAS group was 45 (39, 53) min, significantly longer than 40 (32, 48) min in the control group (P < 0.05). The volume of erythrocyte infusion in the ERAS group was 10 (7, 13) U, significantly less than 18 (10, 28) U in the control group (P < 0.05). The length of postoperative ICU stay and total length of hospital stay in the ERAS group were 135 (84, 212) h and 24 (18, 33) d, significantly shorter than 154 (103, 253) h and 34 (20, 50) d in the control group (both P < 0.05). Total ventilator removal time at postoperative 28 d was 26 (25, 27) d, significantly longer than 26 (23, 27) d in the control group (P < 0.05). The postoperative re-intubation rate in the ERAS group was 11.0%, significantly lower than 20.8% in the control group (P < 0.05). The 90 d, 180 d and 1-year survival rates in the ERAS group were 92.8%, which were significantly higher than 81.1%, 78.1% and 75.7% in the control group (all P < 0.05). ERAS and operation time were the independent influencing factors of survival rate of liver transplant recipients (both P < 0.05). Conclusions ERAS after liver transplantation can improve the survival rate of recipient, shorten the length of hospital stay, reduce the re-intubation rate and accelerate the rehabilitation after liver transplantation.

Objective To establish a modified dual liver transplantation rat model. Methods Based on the classic donor Y-shaped double iliac vein recanalization of bilateral liver grafts and portal vein and bile duct of the recipients, the dual liver transplantation rat model was modified by increasing the rat body mass, increasing the right lower lobe of the right graft, appropriate bile duct length, trimming Y-shaped blood vessels, and "triangular" anastomosis. The operation time, cold ischemia time, warm ischemia time and anhepatic phase of dual liver transplantation were recorded. The incidence of postoperative complications of the recipients was observed. The survival rates of the recipients at postoperative 7 and 30 d were calculated. Results The operation time of dual liver transplantation in rat was (114±7) min, the cold ischemia time was (36±3) min, the warm ischemia time was (9.7±1.6) min, and the anhepatic phase was (19.9±2.2) min, respectively. The incidence of postoperative complications in the recipient rats was 31% (5/16) including 2 cases of peritoneal effusion, 1 case of hemorrhage, 1 case of bile leakage and 1 case of respiratory obstruction. The postoperative 7- and 30-d survival rates of the recipient rats were 81%(13/16)、56%(9/16), respectively. Conclusions The modified technique can establish a stable dual liver transplantation rat model, which deserves widespread application.

Objective To summarize the clinical treatment experience of carbapenem-resistant Klebsiella pneumoniae (CRKP) infection after renal transplantation in donation after cardiac death (DCD) era. Methods Clinical data of 10 donors and 17 recipients with CRKP infection after DCD renal transplantation from January 2015 to January 2019 were retrospectively analyzed. Both donors and recipients received bacterial culture and drug sensitivity test. Clinical manifestations, treatment and outcome of CRKP-infected recipients were recorded. Results Seven donors were infected with CRKP. After pretreatment, CRKP in 2 cases turned negative, CRKP in 5 donors did not turn negative. All renal grafts were treated with tigecycline+meropenem+voriconazole lavage to prevent infection. Among 17 recipients with CRKP infection, 11 cases were positive for blood culture, 10 positive for urine culture, 3 positive for sputum culture, 3 positive for incisional secretion and 3 positive for retroperitoneal drainage. Clinical manifestations included fever in 8 cases, rupture and hemorrhage of the transplant renal artery in 7 cases or thrombosis in the transplant renal artery in 1 case, bladder irritation sign in 3 cases and cough with brick red jelly-like sputum in 1 case, respectively. Five patients were treated with tigecycline+meropenem, 1 patient suffered from renal graft loss and 4 recipients died. Twelve patients were treated with ceftazidime-avibactam +meropenem, 3 patients presented with renal graft loss and 1 recipient died. Conclusions CRKP-infected donor is not the absolute contraindication of renal transplantation. Pretreatment of donor infection and early administration of sufficient sensitive antibiotics can cure CRKP infection and improve the clinical prognosis of renal transplant recipients.

Objective To analyze the difference and influential factors of clinical prognosis between liver transplantation with autoimmune liver disease (AILD) and viral hepatitis cirrhosis. Methods Clinical data of 75 recipients undergoing liver transplantation from January 2002 to January 2017 were retrospectively analyzed. All recipients were divided into the AILD group (n=25) and viral hepatitis cirrhosis group (n=50). The intraoperative conditions of the recipients were observed including warm ischemia time, cold ischemia time, operation time, anhepatic phase and blood transfusion volume. Postoperative complications were observed including severe acute kidney injury (AKI), infection, acute rejection, biliary tract-related complications, vascular-related complications and post transplantation diabetes mellitus (PTDM). The follow-up status were monitored after discharge. The prognostic factors of liver transplant recipients were analyzed. Results The warm ischemia time, cold ischemia time, operation time and anhepatic phase did not significantly differ between two groups (all P > 0.05). In the AILD group, the incidence of postoperative acute rejection was remarkably higher, whereas the incidence of postoperative severe AKI was significantly lower than those in the viral hepatitis cirrhosis group (both P < 0.05). The postoperative 1-, 3- and 5-year survival rates in the AILD group was 92%, 87%, and 87%, which did not significantly differ from 88%, 88% and 88% in the viral hepatitis cirrhosis group (all P > 0.05). Univariate analysis showed that age, model for end-stage liver disease (MELD) score, severe AKI, infection and biliary tract-related complications were the influencing factors of clinical prognosis of the recipients (all P < 0.05). Conclusions The overall survival prognosis does not significantly differ between the AILD and viral hepatitis cirrhosis groups. Age, MELD score, severe AKI, infection and biliary tract-related complications are the risk factors affecting the clinical prognosis of liver transplantation recipients.