器官移植

2021 Vol. 12, No. 1

column

Editorial
Diagnosis and Treatment Specification
Banff Allograft Pathology
Academic Summary
Transplantation Forefront
Original Article
Review Article

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Editorial

Attaching importance to mechanical perfusion of donor liver and promoting high-quality development of liver transplantation

Ouyang Qing, Tan Xiaoyu, Huo Feng

2021, 12(1): 1-7. doi: 10.3969/j.issn.1674-7445.2021.01.001

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With the increasing quantity of organ donors and the continual expansion of the definition of extended criteria donor (ECD) livers, the quality of donor liver has become a prominent issue affecting the high-quality development of liver transplantation, which is also the study focus in related fields. Resolving the shortage of organs to the maximal extent and promoting the high-quality development of organ transplantation lead the development direction of organ donation and transplantation in China. In recent years, the application of mechanical perfusion (MP) for the perfusion, preservation, evaluation and repair of donor liver has become a hot topic to improve the quality of liver transplantation within the international community. In this article, according to different conditions of the application of ECD livers in liver transplantation at home and abroad in combination with the research progress on MP in the international community and relevant research experience of our center, the feasibility of establishing an organ intensive care unit (ICU) with integrated organ protection techniques was discussed, aiming to promote the high-quality development of organ transplantation in China and further expand the technical connotation of the "Chinese model" of organ donation and transplantation.

Diagnosis and Treatment Specification

Diagnosis and treatment specification for immunosuppressive therapy and rejection of liver transplantation in China (2019 edition)

Branch of Organ Transplantation of Chinese Medical Association

2021, 12(1): 8-14, 28. doi: 10.3969/j.issn.1674-7445.2021.01.002

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The liver is an "immune-privileged organ". The incidence and severity of acute rejection after liver transplantation are significantly lower than those after the transplantation of other organs. However, postoperative rejection is still relatively common, and standardized immunosuppressive therapy is the key to guarantee the efficacy of transplantation. To further standardize the immunosuppressive therapy and diagnosis and treatment of rejection after liver transplantation, Branch of Organ Transplantation of Chinese Medical Association organized liver transplant experts to summarize the latest research progress at home and abroad, integrate international guidelines and clinical practice and formulate the "Diagnosis and treatment specification for immunosuppressive therapy and rejection of liver transplantation in China (2019 edition)" based upon the application principle and common regime of immunosuppressant, as well as diagnosis and treatment of various types of rejection after liver transplantation.

Banff Allograft Pathology

The origin and development of Banff classification on allograft pathology and its effects in promoting organ transplantation

Guo Hui, Chen Gang

2021, 12(1): 15-22. doi: 10.3969/j.issn.1674-7445.2021.01.003

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The Banff conference on allograft pathology (Banff conference) and the establishment of Banff classification on allograft pathology (Banff classification) are milestones in the development of international allograft pathology. At present, all organ transplantation centers around the world routinely perform pathological diagnosis by biopsy of the transplant kidney according to Banff classification. Subsequently, the consensus process and update mode of Banff classification for transplant kidney was quickly extended to transplant heart, lung, liver, pancreas, and small intestine, etc. The Banff conference has not only become a thematic meeting that includes the pathology study and discussion of various transplant organs, but also gradually developed unified diagnostic standard for the biopsy of each transplant organ, which better promoted the accurate diagnosis and treatment of complications after organ transplantation. This article summarized the history of international allograft pathology research, the Banff conference and Banff classification in promoting organ transplantation, which aimed to provide a reference for the smooth development of clinical organ transplantation.

Academic Summary

International frontier hotspots of basic and translational medicine research related to renal transplantation at the 2020 ATC

He Jiannan, Sun Qiquan

2021, 12(1): 23-28. doi: 10.3969/j.issn.1674-7445.2021.01.004

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The American Transplant Congress (ATC) is an annual international academic conference in the field of transplantation, which includes the latest achievements of scholars around the world in transplantation, and also leads the frontier direction of transplantation research. In this paper, the international forefront hotspots in basic and translational medicine research associated with renal transplantation in 2020 ATC were summarized, including the new discoveries of memory cell function and immune memory mechanism, the latest discovery in the mechanism of rejection and immune tolerance, the current research status of xenotransplantation, the potential solutions of antibody-mediated rejection (AMR), and the application of nanomedicine and single-cell RNA sequencing in renal transplantation, etc.

Summary of the research frontiers of liver transplantation in 2020 ATC

Li Haibo, Wang Guoying, Cai Jianye, Feng Xiao, Zeng Kaining, Yang Yang

2021, 12(1): 29-36. doi: 10.3969/j.issn.1674-7445.2021.01.005

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The American Transplant Congress (ATC) is an influential academic congress in the field of organ transplantation. In this article, the hotspots of liver transplantation in 2020 ATC were summarized, including the latest research progress in donor liver procurement and quality assessment, donor liver preservation and ischemia-reperfusion injury (IRI), liver transplantation for hepatocellular carcinoma and other hepatic malignancies, complications after liver transplantation, transplantation immunology, perioperative management and donor-derived infection, pediatric liver transplantation and cell therapy, etc.

Interpretation of latest literatures on renal transplantation in the third quarter of 2020

Ma Maolin, Shi Bingyi, Sun Qiquan

2021, 12(1): 37-42. doi: 10.3969/j.issn.1674-7445.2021.01.006

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How to improve the long-term prognosis of transplant kidney and solve the shortage of donor kidney are still two major problems that plague clinicians. Among them, ischemia-reperfusion injury (IRI), rejection, infection, and immunosuppressive therapy are important issues in the research field of renal transplantation. Therefore, strengthening the literature study in the field of renal transplantation and understanding the nature of transplant kidney related diseases and international frontier research hotspots, help to further improve the function and prolong the survival time of the transplant kidney in clinic. This article interpreted literatures on the research hotspots and new progress in the field of renal transplantation in the third quarter of 2020, combined with the meeting minutes of the 12th Lingnan Reading Club, and reviewed from the three aspects of IRI, rejection and infection.

Transplantation Forefront

Research progress of methods to promote the survival of cryopreserved ovarian tissue auto-transplantation

Qu Linghan, Yu Zhou, Song Baoqiang

2021, 12(1): 43-50. doi: 10.3969/j.issn.1674-7445.2021.01.007

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With the technology development of cancer treatment, the survival rate of patients with cancer has been significantly improved. However, chemotherapy and radiation therapy may lead to premature ovarian failure and infertility in young women with cancer. Cryopreserved ovarian tissue auto-transplantation is an effective method to preserve fertility of such female patients. At present, the biggest challenge of this technique is mass loss of follicles after transplantation. In this article, the influencing factors and improvement methods of survival of cryopreserved ovarian tissue auto-transplantation were reviewed.

Original Article

Preliminary report of preclinical trial of multi-genome engineering pig-to-macaque heart, liver and kidney transplantation

Zhang Xuan, Wang Lin, Zhang Hongtao, Yang Zhaoxu, Yue Shuqiang, Yang Yanling, Dong Hailong, Chen Min, Lu Zhihong, Cheng Liang, Liu Jincheng, Yu Shiqiang, Zhang Geng, Qin Weijun, Li Jipeng, Wei Hongjiang, Yang Luhan, Zhou Liang, Long Enwu, Tao Kaishan, Dou Kefeng

2021, 12(1): 51-56. doi: 10.3969/j.issn.1674-7445.2021.01.008

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Objective To investigate the application prospect of the most extensive genome engineering pig internationally in preclinical xenotransplantation. Methods Porcine endogenous retrovirus (PERV) knockout combined with 3 major heterologous antigen gene knockouts and 9 humanized genes for inhibition of complement activation, regulation of coagulation disorders, anti-inflammatory and anti-phagocytosis were transferred into a pig (PERV-KO/3-KO/9-TG) as a donor, and the heart, liver and kidney were obtained and transplanted to 3 Rhesus macaque recipients respectively to establish a preclinical research model of pig-to-Rhesus macaque xenotransplantation. The functional status of xenografts after blood flow reconstruction was observed and the survival of recipients was summarized. The hemodynamics of xenografts were monitored. The change of hematological indexes of each recipient was compared. The histopathological manifestation of xenografts was observed. Results After the blood flow was reconstructed, all xenografts showed ruddy color, soft texture and good perfusion. The transplant heart, liver and kidney showed full arterial and venous blood flow and good perfusion at 1 d after operation. The postoperative survival time of heart, liver, and kidney transplant recipients was 7, 26, and 1 d, respectively. The levels of creatine kinase, creatine kinase isoenzyme, and lactate dehydrogenase increased in heart transplant recipient at 1 d after operation, and gradually recovered to near normal levels at 6 d after operation. All indexes increased sharply at 7 d after operation. The level of aspartate aminotransferase increased in liver transplant recipients at 2 d after operation, and the alanine aminotransferase basically returned to normal at 10 d after operation, but the total bilirubin continued to increase. Both aspartate aminotransferase and alanine aminotransferase increased at 12 d after operation, and reached a peak at 15 d after operation. The kidney transplant recipient developed mild proteinuria at 1 d after operation, and died of sudden severe arrhythmia. Histopathology showed that the tissue structure of cardiac and renal xenografts was close to normal, and liver xenografts presented with patchy necrosis, the liver tissue structure was disordered, accompanied by inflammatory damage, interstitial hemorrhage and thrombotic microangiopathy. Conclusions PERV-KO/3-KO/9-TG pig shows advantages in overcoming hyperacute rejection, mitigating humoral rejection and coagulation dysregulation. However, whether it can be used as potential donor for clinical xenotransplantation needs further evaluation.

Preliminary study of effect of erythropoietin pretreatment on enhancing directional homing ability of bone marrow mesenchymal stem cells in rats

Qiao Yuming, Zhou Song, Zhang Ya, Liu Yongguang, Zhao Ming

2021, 12(1): 57-63. doi: 10.3969/j.issn.1674-7445.2021.01.009

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Objective To evaluate the effect of erythropoietin (EPO) on the proliferation and migration of bone marrow mesenchymal stem cell (BMSC) in rats. Methods The 5th generation BMSCs were divided into the control (without EPO) and 10, 100, 500, 1 000 IU/mL EPO groups. After 24 h and 48 h of culture, the proliferation rate, migration ability and the expression levels of CXCR4 of BMSCs were detected in each group. The 5th generation BMSCs were further divided into BMSC and EPO-BMSC groups. After 48 h of culture, the effect of EPO upon surface markers, directional differentiation and cytoskeleton morphology of BMSCs were evaluated in both groups. Results After theco-culture of EPO and BMSCs for 48 h, the proliferation rate and migration ability of BMSCs were significantly enhanced, and the expression level of CXCR4 protein was significantly up-regulated in the 100 IU/mL and 500 IU/mL EPO groups compared with those in the control group (all P < 0.05). However, EPO exerted no effect upon the expression levels of surface markers and directional differentiation ability of BMSCs in the EPO-BMSC group. In the EPO-BMSC group, the fibrous skeleton of most BMSCs was arranged along the long axis in parallel. Conclusions EPO can improve the proliferation rate, migration ability and tissue repair capability of BMSCs, probably by promoting the directional homing of BMSCs to injured organs and tissues via up-regulating the expression level of CXCR4.

Multi-disciplinary team of the treatment of heart transplantation for Danon disease

Lin Hengqiang, Liu Sheng, Huang Jie, Du Juan, Chen Lei, Wang Hongyue

2021, 12(1): 64-69. doi: 10.3969/j.issn.1674-7445.2021.01.010

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Objective To improve the understanding of Danon disease and the efficacy of heart transplantation by multi-disciplinary team (MDT) pattern. Methods Prior to heart transplantation, MDT consultation was performed on one case of Danon disease, an extremely rare X-chromosome dominant genetic disease. The content of consultation included surgical indication, preoperative preparation and postoperative precaution, as well as the role of MDT in the treatment of Danon disease was summarized. Results Preoperative echocardiography showed that the patient presented withdilated-phase of hypertrophic cardiomyopathy complicated with heart failure, which was considered as Danon disease with end-stage heart failure. After MDT consultation, the patient received the preoperative treatment including anti-heart failure, reduction of pulmonary artery pressure, intra-aortic balloon pump (IABP) assistance, liver protection, strengthening nutritional support, etc. The patient underwent orthotopic heart transplantation after a suitable donor was matched. The patient developed muscle weakness in the limbs 5 days after operation, which was gradually mitigated after reducing the dose of glucocorticoid. At postoperative 48 days, the patient was discharged in good condition and continually treated with triple immunosuppressive regimen after discharge. Reexamination at postoperative 6 months revealed that the patient was in good health without any abnormality in electrocardiogram and echocardiography images. Conclusions Danon disease is extremely rare and MDT pattern may enhance the efficacy and safety of treatment by heart transplantation.

Multi-disciplinary team on acute heart failure complicated with respiratory failure after allograft nephrectomy

Lyu Guangna, Li Ning, Ning Yuan, Guo Wenping

2021, 12(1): 70-76. doi: 10.3969/j.issn.1674-7445.2021.01.011

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Objective To evaluate the effect of multi-disciplinary team (MDT) on acute heart failure (AHF) complicated with respiratory failure after allograft nephrectomy. Methods MDT discussion was performed on a patient with hemorrhagic shock caused by sudden renal graft hemorrhage, who developed acute myocardial infarction (AMI) with AHF, acute pulmonary congestion, pulmonary infection and acute respiratory failure 2 weeks after allograft nephrectomy. And treatment plan was formulated and effect evaluation was conducted. Results Based on the opinions of MDT discussion, the patient was given nasal high-flow oxygen therapy, continuous veno-venous hemodiafiltration (CVVHDF) to reduce cardiac load, anticoagulant, dilating blood vessels, reducing myocardial oxygen consumption, improving myocardial remodeling, lipid regulation, anti-infection, nutritional support, and other comprehensive treatment. The clinical outcome of the patient was good and regular hemodialysis treatment was resumed. Conclusions Application of MDT pattern helps to formulate a comprehensive and effective individualized treatment plan for patients with AHF and respiratory failure after allograft nephrectomy, which can enhance clinical treatment effects and improve prognosis of patient.

Multi-disciplinary team on renal allograft dysfunction induced by recurrence of primary hyperoxaluria type I after renal transplantation

Wang Yuchen, Yan Ziyan, Deng Wenfeng, Xia Renfei, Zeng Wenli, Luo Jia, Xu Jian, Miao Yun

2021, 12(1): 77-82. doi: 10.3969/j.issn.1674-7445.2021.01.012

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Objective To investigate the clinical characteristics and the experience of multi-disciplinary team (MDT) on recurrence of primary hyperoxaluria (PH) type I after renal transplantation. Methods One case presenting with unexplained rapid decline of renal allograft function after allogeneic renal transplantation was discussed by MDT. The role of MDT in diagnosing rare hereditary diseases and improving the long-term survival of renal transplant recipients was summarized. Results After MDT consultation, the patient was diagnosed with recurrence of PH type I. Routine immunosuppressive regimen was initiated after the exclusion of rejection. The patient was instructed to drink a large quantity of water, and given with high-quality protein and low-phosphorus diet, vitamin B6, calcium and other conservative therapies to actively prevent and treat postoperative complications. The deterioration of renal graft function was delayed. Nevertheless, regular hemodialysis was resumed at 5 months after renal transplantation until the submission date of this manuscript. Conclusions Recurrence of PH type I after renal transplantation is relatively rare. The main clinical manifestations are recurrent kidney stones and decreased renal function with multiple complications and poor prognosis. The condition of the patient is consulted by MDT for confirming the diagnosis, determining the optimal treatment scheme, delaying the progression and improving the clinical prognosis.

Analysis on dynamic changes of T lymphocyte subsets in recipients with stable graft status after lung transplantation

Lian Qiaoyan, Chen Ao, Xu Xin, Wei Bing, Cai Yuhang, Huang Danxia, He Jianxing, Ju Chunrong

2021, 12(1): 83-89. doi: 10.3969/j.issn.1674-7445.2021.01.013

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Objective To analyze the dynamic changes and the influencing factors of T lymphocyte subsets in recipients with stable graft status within 1 year after lung transplantation. Methods Clinical data of 41 recipients with stable graft status after allogeneic lung transplantation were analyzed. The absolute value and ratio of T lymphocyte subsets in peripheral blood from recipients were measured by flow cytometry before operation, 2 weeks and each month (within 1 year) after operation, respectively. The effects of age, gender, body mass index (BMI), surgical method, incidence of primary graft dysfunction (PGD) after operation, and primary disease upon the absolute values of T lymphocytes were evaluated. Results Within 1 year after lung transplantation, the absolute values of CD3⁺, CD3⁺CD4⁺, CD3⁺CD8⁺T lymphocytes and CD4⁺/CD8⁺ ratio were changed over time (all P < 0.001). Compared with preoperative values, there was no statistical significance in the absolute values of CD3⁺ and CD3⁺CD4⁺T lymphocytes at 12 months after operation (P=0.659, 0.109), whereas the absolute value of CD3⁺CD8⁺T lymphocytes was increased (P=0.02) and the CD4⁺/CD8⁺ ratio was decreased (P < 0.001). Age, gender, BMI, surgical method and incidence of PGD after operation exerted no significant effect on the dynamic changes of absolute values of CD3⁺CD4⁺ and CD3⁺CD8⁺T lymphocytes (all P > 0.05). Primary disease before lung transplantation exerted no effect on the changes of CD3⁺CD4⁺T lymphocytes, whereas the postoperative absolute value of CD3⁺CD8⁺T lymphocytes was higher in recipients with infectious lung diseases (P < 0.05). Conclusions The absolute values of CD3⁺, CD3⁺CD4⁺, CD3⁺CD8⁺T lymphocytes in recipients with stable graft status after lung transplantation are relatively low in the early stage after lung transplantation, then gradually restore, and stabilize at 6 months after operation. Dynamic changes are not associated with age, gender, BMI, surgical method and incidence of PGD after operation of recipients.

Diagnosis and treatment of hepatic sinusoidal obstruction syndrome after liver transplantation: a single-center experience

Liu Ying, Sun Liying, Zhu Zhijun, Wei Lin, Qu Wei, Zeng Zhigui, Zhao Xinyan

2021, 12(1): 90-95. doi: 10.3969/j.issn.1674-7445.2021.01.014

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Objective To summarize the incidence, diagnostic and therapeutic experience of hepatic sinusoidal obstruction syndrome (HSOS) after liver transplantation. Methods Clinical data of 4 patients with HSOS after liver transplantation were retrospectively analyzed. The incidence, clinical manifestations, imaging and pathological characteristics of HSOS after liver transplantation were collected, and the treatment methods and clinical outcomes of patients with HSOS were analyzed. Results The incidence of HSOS after liver transplantation was 0.8%(2/239), and the median time of onset was 4.5(1.7, 9.0) months after liver transplantation. The clinical manifestations of HSOS mainly included abdominal distension, ascites, hepatomegaly, increased bilirubin, and renal insufficiency in partial cases. Enhanced abdominal CT scan of 4 patients with HSOS showed uneven spot-like enhancement and the liver histopathological examination mainly showed the signs of hepatic sinusoidal dilatation complicated with congestion. Four patients were administered with an adjusted regime of immunosuppressant by replacing tacrolimus (Tac) with ciclosporin and adding anticoagulant therapy with warfarin. One patient received transjugular intrahepatic portosystemic shunt (TIPS). After treatment, the symptoms of 3 patients were completely relieved, and 1 patient died. One of the 3 surviving patients died from pulmonary infection and gastrointestinal bleeding. Conclusions HSOS is a rare and fatal complication after liver transplantation. Timely diagnosis and treatment can avoid the incidence of graft failure and improve clinical prognosis of the patients.

Application of quantitative detection of multiple-source cytomegalovirus DNA in diagnosis of cytomegalovirus pneumonia after allogeneic hematopoietic stem cell transplantation

Cheng Haoyu, Yang Fan, Yang Yixin, Zhang Shuqin, Zhang Yongping, Zhang Weijie, Fei Xinhong, Yin Yuming, Gu Jiangying, Wang Jingbo

2021, 12(1): 96-102. doi: 10.3969/j.issn.1674-7445.2021.01.015

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Objective To evaluate the diagnostic value of quantitative detection of cytomegalovirus (CMV) DNA from different sources [plasma, sputum and bronchoalveolar lavage fluid(BALF)] for CMV pneumonia after allogeneic hematopoietic stem cell transplantation. Methods Clinical data of 405 recipients undergoing allogeneic hematopoietic stem cell transplantation were retrospectively analyzed. Among them, 19 recipients diagnosed with CMV pneumonia were assigned into the CMV pneumonia group, and 229 recipients with CMV viremia alone, 11 recipients without CMV pneumonia who received fiberoptic bronchoscopy and 16 recipients diagnosed with bacterial or fungal pneumonia based on pathogenic evidence receiving sputum culture were assigned into the control A, B and C groups, respectively. The incidence of CMV pneumonia was summarized. The CMV DNA load of specimens from different sources (plasma, sputum and BALF) of recipients with CMV pneumonia was analyzed. The clinical prognosis of recipients with CMV pneumonia was evaluated. Results Among 405 recipients undergoing allogeneic hematopoietic stem cell transplantation, 19 cases developed CMV pneumonia, and the overall incidence of CMV pneumonia was 4.7%(19/405). The CMV DNA load in the plasma, sputum and BALF of recipients with CMV pneumonia was higher than those in the control A, B and C groups (all P < 0.05). In the 19 recipients, 12 cases were cured after antiviral treatment and 7 died from treatment failure(3 cases abandoned treatment). The fatality was 37%(7/19). Conclusions Quantitative detection of CMV DNA in the plasma, sputum and BALF may increase the diagnostic rate of CMV pneumonia, thereby improving clinical prognosis of recipients undergoing allogeneic hematopoietic stem cell transplantation.

Application value of ultrasound elastography in evaluating liver elasticity of stable recipients at different stages after liver transplantation

Li Qinyuan, Jiang Wei, Feng Cheng, Zhao Ningbo, Wang Xinfa, Dong Changfeng

2021, 12(1): 103-108. doi: 10.3969/j.issn.1674-7445.2021.01.016

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Objective To explore the value of ultrasound elastography in the non-invasive monitoring of liver elasticity of stable recipients at different stages after liver transplantation. Methods Clinical data of 73 stable recipients after liver transplantation were collected. According to the time after liver transplantation, all patients were divided into the early group (n=25) and medium-to-long group (n=48). In addition, 38 healthy subjects were assigned into the control group. The ultrasound indexes and liver function indexes were statistically compared among each group. The ultrasound elastography indexes of liver and spleen were analyzed, and their correlation with liver function indexes was analyzed. Results Compared with the control group, the ultrasound indexes, alanine aminotransferase (ALT), γ-glutamyl transferase (GGT) and alkaline phosphatase (ALP) levels were significantly increased in the early group (all P < 0.05), and the ultrasound indexes in the medium-to-long group were significantly increased, whereas the GGT level was significantly decreased (all P < 0.05). Compared with the early group, the right oblique diameter of liver, ALT, GGT and ALP levels were significantly decreased in the medium-to-long group (all P < 0.05). Compared with the control group, the sound touch elastography (STE) and sound touch quantify (STQ) values of liver and STE value of spleen in the early group and medium-to-long group were significantly increased (all P < 0.05). Compared with the early group, the ultrasound elastography indexes of liver and spleen in the medium-to-long group were remarkably decreased (all P < 0.05). The ultrasound elastography indexes of liver were weakly correlated with the ALT, aspartate aminotransferase (AST) and GGT levels, significantly correlated with ALP level. The STE value of spleen was weakly correlated with the ALP level. The STE value of liver was significantly correlated with the STQ value of liver. The STE and STQ values of liver were weakly correlated with the STE value of spleen. Conclusions The characteristics of liver elasticity in stable recipients after liver transplantation are various among different stages. Persistent monitoring of liver elasticity may provide a novelnon-invasive monitoring method during follow-up after liver transplantation.

Review Article

Research progress on trogocytosis of immune cell in transplantation immunity

Zhao Yang, Zhou Lin, He Qiang

2021, 12(1): 109-114. doi: 10.3969/j.issn.1674-7445.2021.01.017

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Trogocytosis is a process of exchanging part of the membrane fragment or cytoplasmic content of cells through direct contact, and it's an interaction mechanism that exists between cells. Immune cell can obtain some characteristics of other cells through trogocytosis, and the new cells generated through trogocytosis may play an important role in the induction of graft immune tolerance. In this article, the origin and development of research on cell trogocytosis, mechanism of cell trogocytosis and biological significance of trogocytosis of immune cell were reviewed.

Research progress on strategies of reducing perioperative blood transfusion in liver transplantation

Zhang Li, Yang Jian, Jiang Wentao

2021, 12(1): 115-119. doi: 10.3969/j.issn.1674-7445.2021.01.018

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Massive blood loss and blood transfusion constantly occur in liver transplantation. Over the past two decades, the amount of blood transfusion during the perioperative period has been decreased dramatically along with the continual maturity of liver transplantation techniques. The goal of liver transplantation without blood transfusion has been achieved. Since bleeding and blood transfusion are correlated with poor prognosis after liver transplantation, reducing bleeding and unnecessary blood transfusion has become the key objective during perioperative period of liver transplantation. In this article, adverse effects of allogeneic blood transfusion during perioperative period of liver transplantation, coagulation function monitoring of patients with end-stage liver disease, blood transfusion management of liver transplant recipients and the strategies of reducing perioperative blood transfusion in liver transplantation were summarized, aiming to provide reference for reducing the requirement of blood transfusion during perioperative period of liver transplantation.