Introduction: New-onset diabetes after transplantation (NODAT) is a clinically significant complication associated with adverse metabolic and graft outcomes and affects patients’ quality of life. Data in paediatric populations are limited. This case series describes the incidence, clinical characteristics, and early outcomes of NODAT in a paediatric kidney transplant cohort. Cases: Thirty patients (aged 5–17 years; 16 males, 14 females; 14 Malay, 15 Chinese, 1 Indian) underwent renal transplantation at Hospital Tunku Azizah between 2019 and 2025. NODAT was identified using standard diagnostic criteria and occurred in four patients (13.3%). Among patients who developed NODAT, three were Malay and one Chinese; all were aged 10–17 years, with a predominance of females (n = 3). All were non-obese (body mass index [BMI]: 11–21.4 kg/m²), and only one had a family history of type 2 diabetes mellitus. Underlying causes of ESRF in these patients included focal segmental glomerulosclerosis (FSGS, n = 2), CAKUT (n = 1), and unknown etiology (n = 1). Two patients received kidneys from living donors, and two from cadaveric donors. Two patients demonstrated reduced C-peptide levels, consistent with impaired insulin secretion. All patients received steroid induction and maintenance therapy alongside tacrolimus-based immunosuppression, with one patient also receiving everolimus. Two patients developed post-transplant CMV viremia, which has been associated with NODAT. The onset of NODAT was early, occurring within 2 weeks post-transplant in three patients and at 1 month in one patient. Insulin therapy achieved glycemic control in all cases. Two patients were able to discontinue insulin within 3–4 months, suggesting recovery of endogenous glycemic regulation, while the remaining two required ongoing insulin therapy. Conclusion NODAT affects a substantial proportion of paediatric kidney transplant recipients and may present despite the absence of conventional risk factors. Early surveillance is essential. The observed potential for insulin independence may indicate a reversible component of β-cell dysfunction, which warrants further investigation in larger cohorts.
Child ; Kidney Transplantation ; Hospitals

BACKGROUND : Kidney transplantation improves survival and quality of life in end-stage renal disease. However, intraoperative hypotension remains common and may reduce graft perfusion. The optimal intraoperative blood pressure (BP) target remains unclear. This study aimed to evaluate the association between intraoperative BP trends and kidney transplant outcomes. METHODS : A retrospective cohort study was conducted among adult living donor kidney transplant recipients (≥18 years) at Cipto Mangunkusumo Hospital, Jakarta, Indonesia, from July 2023–April 2025. Intraoperative BP was recorded every 15 min to calculate average, minimum, and hourly systolic blood pressure (SBP), diastolic blood pressure, and mean arterial pressure (MAP). The primary outcomes were 3-month mortality, delayed graft function (DGF), and acute allograft rejection. Secondary outcomes included early graft function parameters, including serum creatinine levels, estimated glomerular filtration rate (eGFR), and time to first diuresis. Associations between BP and outcomes were analyzed using multivariate logistic regression in SPSS software version 27.0, with p<0.05 considered significant. RESULTS : Of 79 transplant recipients, the 3-month mortality was 6.3%, DGF was 7.6%, and acute rejection was 3.8%. Lower intraoperative MAP was associated with increased odds of DGF, with MAP <80 mmHg showing the strongest association (odds ratio [OR]: 88.239; 95% confidence interval [CI]: 2.720–2,092.86). Each 10-mmHg increase in overall SBP was associated with a reduction in the odds of DGF (OR: 0.360; 95% CI: 0.155–0.838). No BP measures were linked to serum creatinine levels (p = 0.083–0.271) or eGFR (p = 0.151–0.791). CONCLUSIONS Lower intraoperative MAP and SBP were associated with higher odds of DGF, highlighting the importance of maintaining adequate BP to optimize kidney transplant outcomes.
blood pressure ; delayed graft function ; graft rejection ; kidney transplantation ; mortality

OBJECTIVE: To compare the therapeutic efficacy of portal and tail vein transplantation of bone marrow-derived mesenchymal stem cells (BMSCs) against cholestatic liver fibrosis in mice. METHODS: BMSCs were isolated and co-cultured with starvation-activated hepatic stellate cells (HSCs). HSC activation markers were identified using immunofluorescence and qRT-PCR. BMSCs were injected into the liver tissues of bile duct ligation (BDL) mice via the tail and portal veins. Histomorphology, liver function, inflammatory cytokines, and the expression of key proteins were all determined in the liver tissues. RESULTS: BMSCs inhibited HSC activation by reducing α-SMA and collagen I expression. Compared to tail vein injection, DIL-labeled BMSCs injected through the portal vein maintained a high homing rate in the liver. Moreover, BMSCs transplanted through the portal vein resulted in greater improvement in liver color, hardness, and gallbladder size than did those transplanted through the tail vein. Furthermore, BMSCs injected by portal vein, but not tail vein, markedly ameliorated liver function, reduced the secretion of inflammatory cytokines, including TNF-α, IL-6, and IL-1β, and decreased α-SMA + hepatic stellate cell (HSC) activation and collagen fiber formation. CONCLUSION The therapeutic effect of BMSCs on cholestatic liver fibrosis in mice via portal vein transplantation was superior to that of tail vein transplantation. This comparative study provides reference information for further BMSC studies focused on clinical cholestatic liver diseases.
Animals ; Mice ; Mesenchymal Stem Cell Transplantation ; Liver Cirrhosis/etiology* ; Male ; Cholestasis/therapy* ; Mice, Inbred C57BL ; Hepatic Stellate Cells ; Mesenchymal Stem Cells

In recent years, digital bone harvesting and grafting technology in dental implantology has emerged as a cutting-edge advancement in the field of oral medicine, gaining widespread application in the treatment of complex bone defect cases. By integrating digital imaging, virtual design, and precise surgical guidance, this technology has significantly enhanced the success rate of dental implants and improved patient outcomes. However, the rapid development of this technology has also highlighted the lack of standardized clinical protocols, necessitating the establishment of unified guidelines through expert consensus. This article provides a detailed overview of the development process of the group standard Clinical Protocol for Bone Harvesting and Grafting under Digital Guidance in Oral Implantology and offers an in-depth interpretation of its key components, aiming to serve as a valuable reference for clinical practice and academic research.
Humans ; Bone Transplantation/methods* ; Surgery, Computer-Assisted/methods* ; Dental Implantation/methods* ; Tissue and Organ Harvesting/methods* ; Clinical Protocols

Pulmonary diseases, as a prevalent category of respiratory system disorders, have become a significant global public health concern. The increasing incidence of these diseases, caused by environmental pollution and occupational hazards, poses a substantial threat to human health and the overall quality of life. Mesenchymal stem cells (MSCs) are known for their remarkable immunomodulatory, anti-bacterial, and anti-apoptotic capabilities. Exosomes derived from MSCs, carrying a diverse array of proteins, lipids, nucleic acids, and other bio-active molecules, have demonstrated considerable therapeutic potential in treating pulmonary diseases, and have come to the forefront of medical research. This review summarized the therapeutic role of exosomes derived from various sources of mesenchymal stem cells in the context of pulmonary diseases, aiming to provide a robust foundation for their clinical application in diagnosis and treatment.
Exosomes/transplantation* ; Humans ; Mesenchymal Stem Cells/metabolism* ; Lung Diseases/therapy* ; Animals

PURPOSE: The purpose of this cadaveric study was to compare the volume and weight of bone graft harvested using the curettage vs. the trephination technique from the anterior iliac crest. METHODS: Embalmed cadavers were studied in this experimental research. The right hemipelvis of each cadaver was used for the trephine bone harvesting technique, whereas the left hemipelvis was used for the conventional curettage technique. The weight and the volume of the harvested bone were measured and statistically compared between the 2 sides. The Wilcoxon Signed-Rank test was employed to compare the graft volume and weight obtained from the right and left sides of the hemipelvis. RESULTS: Ten embalmed adult cadavers were used in this study. All subjects were Caucasian males with a mean age of 59.8 years (range 44 - 73 years) at the time of death. A total of 81 cylindrical bone grafts were harvested from the right iliac crest. In 9 out of 81 (11.1%), the cortex of the ilium was penetrated by the chisel. The mean weight of the bone graft harvested with the trephine technique (26.97 ± 2.32) g was heavier than that harvested with the curettage technique (23.74 ± 2.09) g (p = 0.007). Similarly, the volume of the bone graft was higher in the trephine technique (8.40 ± 0.84) cm³ compared to the curettage technique (6.60 ± 1.26) cm³ (p = 0.011). The trephination technique lasted a mean of (12.76 ± 1.87) min (range 10.30-16.10 min), while the curettage technique lasted a mean of (14.53 ± 0.89) min (range 13.50-16.00 min) (p = 0.028). CONCLUSION: Harvesting anterior iliac crest bone graft with the trephine technique provides a higher bone volume and weight than the conventional curettage technique. The trephine technique might be advocated over the curettage technique, especially when a large amount of autologous bone graft is required. However, a meticulous harvesting technique should be followed to prevent complications. In particular, the three-dimensional anatomy should be kept in mind, and the depth of trephination should be well-controlled. CLINICAL TRIAL REGISTRATION Institutional Review Board registration: 2022/499.
Humans ; Ilium/surgery* ; Male ; Middle Aged ; Aged ; Cadaver ; Curettage/methods* ; Tissue and Organ Harvesting/methods* ; Bone Transplantation/methods* ; Adult ; Trephining/methods*

BACKGROUND: For lung transplant recipients (LTRs), rehabilitation management after lung transplantation is a crucial link affecting the recovery of pulmonary function. This study systematically summarizes and generalizes the relevant evidences on postoperative pulmonary function rehabilitation management in LTRs, thereby providing a basis for formulating clinical strategies for postoperative pulmonary function rehabilitation management in this patient population. METHODS: Based on the "6S" evidence model, a systematic search was conducted in domestic and international databases and websites, including UpToDate, BMJ Best Practice, Cochrane Library, Web of Science, China Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), Wanfang Database, Guidelines International Network (GIN), and China Yimai Tong Guidelines Network, from the establishment of each database to July 2025. Relevant evidences on postoperative pulmonary function rehabilitation management for LTRs were extracted, and two researchers independently conducted quality assessment, evidence extraction, and integration of the included literature. RESULTS: A total of 18 studies were included, consisting of 3 expert consensuses, 4 systematic reviews/evidence summaries, 4 randomized controlled trials (RCTs), 5 quasi-experimental studies, and 2 cohort studies. A total of 30 pieces of best evidence were summarized, covering 8 themes: rehabilitation assessment, early intervention, exercise training, nutritional management, medication management, respiratory function training, psychological support, and long-term follow-up. CONCLUSIONS Based on evidence-based principles, this study summarizes the best evidence for postoperative pulmonary function rehabilitation training in LTRs and proposes 30 clinically applicable recommendations, which provides a theoretical basis for the clinical implementation of pulmonary function rehabilitation management. Clinical medical and nursing staff should combine specific clinical scenarios and professional judgments to translate the evidence into practice, and provide scientific rehabilitation management and guidance for LTRs.
Humans ; Lung Transplantation/rehabilitation* ; Lung/surgery* ; Transplant Recipients

The liver is the main target organ for hematogenous metastases from colorectal cancer, and colorectal liver metastasis is one of the most difficult and challenging situations in the treatment. In order to improve the diagnosis and comprehensive treatment in China, the Guidelines have been edited and revised for seven times since 2008, including the overall evaluation, personalized treatment goals and comprehensive treatments, to prevent the occurrence of liver metastases, increase the local damage rate of liver metastases, prolong long-term survival, and improve quality of life. The revised Guideline version 2025 includes the diagnosis and follow-up, prevention, multidisciplinary team (MDT), surgery and local ablative treatment, neoadjuvant and adjuvant therapy, comprehensive treatment. The revised Guideline emphasizes precision treatment based on genetic molecular typing, especially recommending immune checkpoint inhibitors for dMMR/MSI-H patients, and enriched local treatment methods, such as liver transplantation, yttrium-90 microsphere selective internal radiotherapy, etc. The revised Guideline includes state-of-the-art experience and findings, detailed content, and strong operability.
Humans ; Liver Neoplasms/diagnosis* ; Colorectal Neoplasms/therapy* ; Liver Transplantation ; Practice Guidelines as Topic

Renal autotransplantation (RA) offers significant technical advantages for the management of certain complex renal vascular diseases, such as complex renal aneurysms and renal artery malformations. This report describes a case of a 5-year-old child with a complex left renal artery aneurysm combined with multiple aneurysms. The child was admitted to Peking University People's Hospital in December 2023 due to a one-year history of intermittent abdominal pain, with an abdominal mass detected in the past month. Computed tomography angiography(CTA) revealed multiple vascular anomalies, including: (1) a left renal artery aneurysm, (2) an abdominal aortic aneurysm, and (3) a right iliac artery aneurysm. After a comprehensive evaluation of these findings, the surgical team developed a treatment plan that involved the excision of the left renal artery aneurysm, autotransplantation of the left kidney, and resection of the abdominal aortic aneurysm with an artificial vascular catheterization. During surgery, it was discovered that the left renal artery anatomy was highly complex. The artery had two primary branches, along with an additional polar artery located at the lower pole. The aneurysm was identified at the distal end of the renal artery trunk, with a pronounced bulging at the intersection between the main renal artery trunk and its secondary branches. Due to these structural complexities, the team decided to use an ex vivo surgical approach to repair the aneurysm. Ex vivo repair involves temporarily removing the kidney from the body to repair the renal artery aneurysm with enhanced precision, enabling the surgical team to meticulously reconstruct the complex vascular architecture without the constraints of in vivo manipulation. The ex vivo repair of the renal artery aneurysm was successful, allowing for accurate vascular reconstruction and avoiding potential intraoperative complications. Following the reconstruction, the kidney was autotransplanted back into the child's body, and blood flow was effectively restored to the organ. The therapeutic outcome was excellent, with the child experiencing no postoperative complications. The patient recovered well and was discharged from the hospital in stable condition. This case underscores the value of renal autotransplantation combined with ex vivo repair for pediatric patients with complicated renal artery aneurysms. Through this report, we aim to provide insights and considerations for the surgical treatment of similar cases in children with complex renal vascular anatomy.
Child, Preschool ; Humans ; Aneurysm/surgery* ; Aortic Aneurysm, Abdominal/diagnostic imaging* ; Computed Tomography Angiography ; Iliac Aneurysm/surgery* ; Kidney Transplantation/methods* ; Renal Artery/abnormalities* ; Transplantation, Autologous

OBJECTIVES: End stage renal disease (ESRD) is a major disease that seriously threatens the health of young people, and kidney transplantation is an effective treatment method to improve its prognosis.Young ESRD patients at a critical stage of life development often face significant physical and psychological challenges while waiting for kidney transplantation. Their psychological state directly affects treatment compliance and transplantation outcomes.This study aims to explore the psychological experiences of young patients with end stage renal disease during the waiting period for kidney transplantation, and provide a reference for formulating relevant psychological intervention measures. METHODS: A descriptive qualitative research design was adopted. Using purposive sampling, 20 young ESRD patients awaiting for kidney transplantation at the Transplantation Center of Xiangya Third Hospital, Central South University, from June to August 2024, were recruited. Based on the socio-ecological systems theory, a semi-structured interview outline was developed, and directed content analysis was applied to analyze the interview data. RESULTS: According to the results of qualitative interviews, 3 themes and 9 sub-themes were summarized as follows: Microsystem (disease pain experience, anxiety during transplantation waiting period, cognitive differentiation and coping differences), mesosystem (imbalance of family roles and dependent guilt, physician-patient trust dynamics, ambivalence toward peer support), and macrosystem (decision-making powerlessness caused by information asymmetry, sociocultural stigma and public bias, institutional dependence and passive behavior). CONCLUSIONS Young ESRD patients experience complex psychological experiences during the waiting period for kidney transplantation. Healthcare providers should explore corresponding intervention measures based on patients' psychological status to improve their waiting period experience and promote both physical and mental health.
Humans ; Kidney Transplantation/psychology* ; Kidney Failure, Chronic/surgery* ; Qualitative Research ; Female ; Male ; Adult ; Adaptation, Psychological ; Waiting Lists ; Young Adult ; Adolescent ; Anxiety/psychology*