Objective To build a whole-course nursing quality evaluation system for liver transplanta-tion in children,so as to provide a basis for nursing quality evaluation and management.Methods With Donabedian's"structure-process-outcome"model as the theoretical framework,we employed literature analysis,Delphi method,and hierarchical analysis to determine the contents and weights of indexes in the whole-course nursing quality evaluation system for liver transplantation in children.Results The three rounds of survey based on questionnaires showed the questionnaire recovery rate of 100% ,the expert authority coefficients of 0.95,0.96,and 0.98,and the Kendall's coefficients of concordance of 0.165,0.209,and 0.220,respectively(all P<0.001).The established nursing quality evaluation system included 3 first-level indexes,15 second-level inde-xes,and 67 third-level indexes.Conclusion The whole-course nursing quality evaluation system for liver trans-plantation in children that was built in this study can provide a basis for the evaluation of the nursing quality.

Objective To explore the risk factors for the returning of pediatric liver transplant recipi-ents to the intensive care unit(ICU)and provide reference for the clinical decision-making after surgery.Methods A retrospective analysis was conducted with the information of all the pediatric patients who underwent liver transplantation in Ren Ji Hospital,Shanghai Jiao Tong University School of Medicine and were returned to the ICU from 2019 to 2021.The patients returned to the ICU during hospitalization and the reasons for the return were recorded.Each patient of ICU return was matched with three pediatric patients who did not return to the ICU during hospitalization.The basic information,the vital signs and laboratory indicators on the day of transfer from ICU,immunosuppressants and drug concentrations were compared between the two groups.Multivariate Logistic regression analysis was performed to explore the risk factors for the returning of pediatric liver transplant recipients to the ICU.Results The returning rate of pediatric liver transplant recipients to the ICU was 4.36％,and it was 16.00％within 48 h.The main reasons for the return included respiratory complications,abdominal infections,and hepatic vascular occlusion.Multivariate Logistic regression analysis showed that post-operative red blood cell transfusion(OR=4.554,95％CI=1.743-11.901,P=0.002)and high serum level of uric acid(OR=1.005,95％CI=1.001-1.009,P=0.014)were the risk factors for returning to the ICU.High diastolic blood pressure(OR=0.922,95％CI=0.885-0.960,P＜0.001)and high total protein level(OR=0.937,95％CI=0.891-0.986,P=0.012)were the protective factors for returning to the ICU.Conclusion Post-operative red blood cell transfusion and high serum level of uric acid are independent risk factors for the returning of pediatric liver transplant recipients to the ICU.

Objective:To analyze the research hotspots of foreign liver transplantation nursing, and explore the current research trends in this field.Methods:The subject words of liver transplantation nursing literature included in Web of Science were used as the research object, the retrieval time was from the establishment of the database to November 24, 2021, and Bicomb software was used for word frequency analysis, and SPSS software was used carry out systematic clustering analysis on high-frequency keywords.Results:Two hundred and ninety-four articles were finally included and published in 169 journals. Thirty high-frequency subject words were extracted, accounting for 47.60% of the total frequency. Through co-word cluster analysis, it is found that research hotspots include 7 categories: pediatric liver transplantation and family, quality of life and transitional care, postoperative complications and psychology, organ donation and ethics, treatment compliance, intensive care and psychiatry, nutrition and symptoms management.Conclusions:It is suggested that the future nursing research of liver transplantation in China should focus on pediatric living donor liver transplantation and family management, symptom management of liver transplantation recipients, nutrition management of pediatric liver transplantation recipients, psychiatric complications after transplantation in ICU, nursing ethics of liver transplantation, etc. So as to improve the nursing development level of liver transplantation in China.

Liver transplantation is a mature treatment for children with end-stage liver disease. With the development of surgical techniques, immunosuppressive therapy, and infection monitoring in recent years, there have been significant increases in the survival rates of patients and liver transplants, helping children to achieve long-term survival. Meanwhile, several issues have emerged, such as viral infection, complications, new-onset tumors, quality of life, and self-management. Therefore, this article reviews related issues in long-term survival in children after liver transplantation from the two aspects of medical treatment and nursing and provides several regimens for reference, so as to provide a basis for long-term high-quality survival in children after liver transplantation. Here, these issues are reviewed.

Objective To explore the experience of infantile liver transplantation ,reconstructing portal vein (PV) and avoid the higher incidence of portal vein low flow and complications .Methods The clinical data were reviewed for 152 infantile liver transplantations performed by a single surgery group .And 114 cases with PV risk factors underwent customized PV reconstructions .All of them were diagnosed as cholestatic liver diseases and 106 (93％ ) belonged to biliary atresia .Forty-two cases (36％ ) had 2 or more risk factors .Results Most cases (n= 106 ,93％ ) underwent living donor transplantations using lateral left graft while another 8 cases had deceased donor transplantations . Four types of PV reconstructions were adopted based upon individual conditions :left/right branch of PV trunk (n= 103) ,autogenous patch PV venoplastic reconstruction (n= 3) ,duct-to-duct of PV trunk (n= 5) and donor PV duct-to-recipient confluence of SMV/CV and SV (n= 3) .Graft size reduction was performed when GRWR > 4 .5％ (n= 16) .During a median follow-up period of 6 .5 (1 .5-13) months ,there were 3 LPVF (2 .6％ ) ,2PVS (1 .7％ ) and 1 PVT (0 .8％ ) .Three LPVF cases was corrected by PV stenting ,two cases of PVS were stable after anticoagulation therapy while one PVT case undergoing thromboectomy plus PV stenting resumed a normal PV flow .Conclusions PV reconstruction of high-risk infants require comprehensive risk evaluations ,precise surgical skills and customized strategies .For PV complications ,stenting is both safe and feasible .

Objective: To get some knowledge of the quality of life among the pediatric patients who received the liver transplantation for one year, and analyze the impact factors. Methods: The patients who received the liver transplantation within January to December 2016 were investigated by the questionnaire. The patients′ demographics was investigated by the questionnaire. The patients′ quality of life was got by the scale, and then discuss the demographics′ impact on the quality of life. Results: The total score of quality of life was (68.37±13.90) points. The score of "About My Medicines I" was (76.74±17.26) points, and the score of "About My Medicines II" was (77.90±16.41) points, and the score of My Transplant and Others was (65.92±20.06) points, and the score of Pain and Hurt was (79.43±13.52) points, and the score of "worry" was (54.07±25.59) points, and the score of "Treatment Anxiety" was (54.07±25.59) points, and the score of How I Look was (58.85±28.09) points, and the score of "Communication was (84.67±15.86) points. And the type of insurance and blood type of donors were the impact factors, and the difference was significant (t=2.101, 3.201, P<0.05). Conclusions The quality of life of pediatric patients who received the liver transplantation for one year was relatively low. Whether or not having bought the insurance and the blood type of donors may be the impact factors of the quality of life.

Objective: To explore the key points of nursing in the process of diagnosing and treating the common complication--- post-transplantation lymphoproliferative disorder (PTLD) after pediatric liver transplantation. Methods: The clinical data of 21 children with PTLD after liver transplantation. The key point of nursing in the process of prevention, onset, diagnosis and treatment was summarized. Results: With the individual and combined treatments 18 patients gained remission except for 1 patient died because of perforation and sequent intractable haemorrhage and 2 patient died for the development of lymphoma. In terms of nursing, during the prevention stage, it is critical to insist the regular follow-up to make early diagnosis. More efforts should be made to obtain the children′s cooperation to complete the examination. During the infusion of rituximab, strengthened monitoring is necessary and more attention should be paid to the special nursing when other complications such as intractable haemorrhage, intestinal obstruction or perforation occurs. Conclusions The nursing care of PTLD is complicated. Individual and careful nursing regimens should be made based on the specific situations in different stages.

Objective: We observed the effect of the opening and closing pressure sensors on the pediatric liver transplantation. Methods: The 100 cases of pediatric patients who suffered biliary atresia were chose to this study from July 1^st 2018 to Dec 31^st 2018. They received the living donor liver transplantation. The samples were divided into control group and test group according to the random number table. We observed the volume of blood lost during the process of blood sample collecting. The hemoglobin (HB) and infection rate of catheter were also recorded. Results: The test group didn′t lose blood when collecting the sample, and the time of collecting the blood sample in the test group was (22.0 ± 4.2) s, which was shorter than that of in the control group (47.0 ± 7.8) s, the difference was significant, t=9.321, P<0.05. The difference of HB and infection rate of catheter after 24 hours between two groups was not significant, P>0.05. Conclusion The closing pressure sensor may be more advanced when used to avoid the loss of blood and prevent the infection.

Objective: This research was designed to survey the quality of life (QOL) and sleep of the pediatric patients with end-staged liver diseases. Methods: The Pediatric Quality of Life Inventory^TM and the Pediatric Sleep Questionnaire were adapted to develop the questionnaire of the survey. The patients of first half year of 2017 were investigated. Results: The median age was 8 month, and median height was 66 cm, while the median weight was 7.45 kg respectively. The median score of QOL was 67.4, and the median score of sleep was 0.22, while the median score of indirect sleep was 0.33 respectively. Conclusions The QOL of pediatric patients with end-staged liver diseases was relatively low, and the age, monthly income, weight, height were the impact factor of it. The quality of sleep was relatively good, and "whether having the insurance or not" is the impact factor of it.

Objective To survey the parents′satisfaction of clinical decision who have children with end-staged liver diseases. Methods The Questionnaire of Satisfaction of Clinical Decision was used as the instrument. Results The parents′satisfaction score 3 months after the surgery was (71.2 ±3.5) points, while 1 year after the surgery was (68.3±4.4) points, and the difference between them was not statistically, P value was more than 0.05. Besides, the satisfaction showed significant difference on the factors of education and monthly income. F values were 5.258 and 6.328, and P values were both less than 0.05. The stronger the education background was, the higher the satisfaction was. And so the monthly income was. Conclusions The parents have higher satisfaction of clinical decision, and the education and monthly income are the factors affecting the satisfaction.