The development of organ donation and transplantation after citizens' death in our country has been rapid. Long-distance and long-time organ transport has become a routine task. Efficient and safe transportation and data management of donated organs are the core links to ensure the standardized conduct of organ transplantation work. In order to implement the relevant provisions of "Regulations on human organ donation and transplantation" and to fully leverage the policy effectiveness of "Green channel for organ transport in China", to standardize and improve the quality of organ transport work in transplant units and their respective provincial regions and even the whole country, experts in the industry have been organized to formulate "Expert consensus of Chinese transplant organ transport". By establishing standardized transport procedures, technical indicator systems and information platforms, the standardization and standard level of organ transport work will be further improved, and the high-quality development of organ donation and transplantation in our country will be promoted.

Organ transplantation is an effective alternative treatment for patients with end-stage organ failure. However, the shortage of donor organs has limited the widespread application of clinical transplantation. In recent years, breakthroughs in CRISPR-Cas9 gene editing technology have overcome the barrier of hyperacute rejection in xenotransplantation, offering a potential solution to the organ shortage crisis. Rejection remains a critical factor affecting graft survival. Antigen-presenting cells play a vital role in the initiation and progression of rejection and immune regulation in xenotransplantation. Therefore, in-depth investigation into the role of antigen-presenting cells in xenotransplantation is of great significance. This article summarizes the roles and therapeutic strategies of professional antigen-presenting cells, including macrophages, dendritic cells and B cells in xenotransplantation, aiming to provide insights for future research on immune regulation mechanisms in this field.

China’s organ donation undertaking has gradually developed an organ donation and transplantation management system that aligns with international standards while also suiting China’s national conditions, driven by a dual mechanism of administrative and philosophical guidance. At present, this field still faces complex ethical tensions involving individual rights, family ethics, fairness in the allocation of medical resources, and the conflict between traditional cultural values and modern concepts of life. This situation is partly due to the fact that domestic ethical research on organ donation has largely been shaped by specific policy needs and has lagged behind the rapid development of practice and institutional construction. It also reflects significant differences between Chinese and Western ethical perspectives on organ donation, particularly regarding concepts of bodily ownership, ethical subjectivity and distributive justice. To achieve mature development and gain deeper societal acceptance, China’s organ donation undertaking urgently needs to fully leverage the guiding role of philosophical thinking: exploring common ground between traditional ethics and modern donation ethics; promoting the local adaptation of death-related philosophical concepts; dismantling traditional notions of bodily integrity that hinder donation; ensuring substantive autonomy for vulnerable groups; reinforcing the principles of voluntary donation, fair distribution and respect for life; building a multi-layered incentive system; and strengthening public education and value guidance. These efforts will lay a solid ethical foundation for the sustainable development of organ donation in China.

As a pivotal strategy to alleviate the shortage of organ donors, xenotransplantation has achieved remarkable advances in both pre-clinical and clinical studies in recent years, driven by continuous optimization of gene modification techniques and immunosuppressive regimens. Nevertheless, clinical translation still confronts formidable challenges, including rejection and heightened infection risks, which severely compromise long-term graft survival. Consequently, the role of immunosuppressive regimens in xenotransplantation has become increasingly prominent. This article summarizes the mechanisms underlying xenogeneic immune rejection, the latest developments in immunosuppressive regimens, cutting-edge strategies for inducing immune tolerance and the major hurdles facing clinical xenotransplantation. It delves into potential optimization strategies and directions for future clinical research, aiming to offer theoretical insights and practical guidance for the safe and effective application of clinical xenotransplantation.

Thrombotic microangiopathy (TMA) after kidney transplantation is a rare but serious complication characterized by microangiopathic hemolytic anemia, thrombocytopenia and graft dysfunction. It is an important cause of both graft loss and recipient death. The etiology of TMA after kidney transplantation is complex, encompassing calcineurin-inhibitor toxicity, antibody-mediated rejection, infection and drug factors. In recent years, with the in-depth understanding of the core role of the complement system in TMA after kidney transplantation, the application of complement C5 inhibitors (such as eculizumab and ravulizumab) has completely changed the treatment landscape and prognosis of this disease. Therefore, this article aims to provide a systematic review of the progress in the diagnosis and treatment of TMA after kidney transplantation based on the latest literature in recent years, from the aspects of etiology, diagnosis treatment and prognosis, in order to provide a reference for the clinical management of TMA after kidney transplantation.

Kidney transplantation is the most effective treatment for end-stage renal failure, and antibody-mediated rejection remains the leading cause of late allograft loss. Macrophages, as central effectors of innate immunity, play a crucial role in the initiation, progression and tissue damage of antibody-mediated rejection. This article reviews the spatiotemporal dynamic evolution of macrophage polarization status in different stages of antibody-mediated rejection, the fine regulation of key signaling pathways for macrophage polarization, macrophage related molecules and the application prospects of targeted macrophage therapy. In depth analysis of the research progress of macrophages in antibody-mediated rejection, aiming to provide important theoretical basis for the development of precision diagnostic tools based on macrophages and novel immune intervention targets for antibody mediated rejection, ultimately promoting the improvement of long-term prognosis in kidney transplantation.

Heparin-binding protein (HBP) is a pro-inflammatory granule protein released by activated neutrophils, known for its role in modulating vascular permeability and its pathological significance in infectious diseases. In recent years, HBP has garnered attention due to its immune-activating effects in contexts such as sepsis, acute lung injury and organ transplantation. It has been proposed as a potential biomarker for early detection of infection and inflammation. While preliminary progress has been made in animal studies, clinical evidence remains limited. Therefore, this article focuses on the mechanism of action of HBP in transplantation-related complications, explores its potential pathways for predicting infection risk, mediating ischemia-reperfusion injury and rejection, and evaluates the feasibility of intervention strategies such as neutralizing antibodies, heparin derivatives and albumin. The pivotal role of HBP in regulating inflammatory responses post-transplant may offer a novel target for postoperative infection monitoring and personalized therapeutic interventions.

Myosteatosis is one of the common complications in patients with end-stage liver disease, which is significantly associated with poor outcomes after liver transplantation. Currently, diagnostic criteria of myosteatosis have not been established, and CT is the most commonly used for diagnosis. The pathogenesis of myosteatosis is multifactorial, and the pathophysiological mechanisms linking it to end-stage liver disease are not fully understood. An increasing number of scholars have recognized that the severity of myosteatosis is closely related to its clinical consequences, but there are no effective treatment options available. This article reviews the pathophysiological mechanisms and diagnostic methods of myosteatosis, and its impact on the prognosis of liver transplant recipients, and discusses current treatment strategies to provide references for the perioperative management of liver transplant recipients.

Objective To explore the clinical efficacy of plasma exchange (PE) and double-filtration plasmapheresis (DFPP) pretreatment regimens for high-titer ABO-incompatible kidney transplantation (ABOi-KT). Methods A retrospective analysis was conducted on 31 cases of ABOi-KT with a follow-up period ≥1 year admitted to Zhongshan Hospital Affiliated to Fudan University from April 2016 to August 2025. The efficacy differences between the PE combined with rituximab (RTX) + oral triple immunosuppressive regimen and the DFPP combined with RTX + oral triple immunosuppressive regimen were compared and analyzed. The titers of blood group antibodies and serum creatinine levels before and after the operation were monitored. The survival curves and cumulative risk occurrence curves were plotted using the Kaplan-Meier method. The survival rates of recipients and transplanted kidneys and the occurrence of complications were analyzed. Results Both the PE regimen and the DFPP regimen may effectively reduce the preoperative blood group antibody titer of the recipients to ≤1∶16. The one-year survival rate of the recipients and the transplanted kidneys both reached 100% after the operation. The postoperative serum creatinine levels of recipients who received the DFPP regimen were lower and more stable. There was no statistically significant difference in the incidence of complications between the two regimens during the same follow-up period. Conclusions Both the PE and DFPP regimens are effective pretreatment regimens for ABOi-KT. The DFPP regimen has more advantages in reducing treatment operations, lowering drug dosage and maintaining the stability of postoperative renal function. For recipients with a high initial antibody titer (≥ 1∶32), individualized determination of the number and frequency of plasma processing for pretreatment may achieve ideal therapeutic effects.

Objective To explore factors affecting the postoperative renal function and surgical complications in recipients of living donor kidney transplantation. Methods A retrospective analysis was conducted on medical records of 119 patients who underwent living donor kidney transplantation at Beijing Friendship Hospital Affiliated to Capital Medical University, from January 2020 to September 2024. The severity of surgical complications was evaluated using the Clavien-Dindo score. Spearman correlation analysis was used to analyze the correlation between preoperative general data, surgical data, preoperative laboratory data and the Clavien-Dindo score. Multiple linear regression analysis was performed on the correlated factors. Univariate and multivariate logistic regression analyses were used to analyze the factors affecting the occurrence of delayed graft function (DGF) after surgery. Results The body mass index, history of hypertension, cold ischemia time, the first warm ischemia time, the second warm ischemia time, prothrombin activity and international normalized ratio were all correlated with the Clavien-Dindo score. Multiple linear regression analysis showed that the longer the second warm ischemia time and the first warm ischemia time were, the higher the Clavien-Dindo score was, and the more severe the postoperative surgical complications were (all P<0.05). Multivariate logistic regression analysis showed that long the first warm ischemia time and long dialysis time were independent risk factors for the occurrence of DGF after surgery (all P<0.05). Conclusions Prolonged the second warm ischemia time and the first warm ischemia time may increase the severity of surgical complications in recipients after living donor kidney transplantation. Long the first warm ischemia time and long dialysis time are independent risk factors for the occurrence of DGF after surgery.