Decision-making based on artificial intelligence(AI)methodology is increasingly present in all areas of modern medicine.In recent years,models based on deep-learning have begun to be used in organ transplantation.Taki...Decision-making based on artificial intelligence(AI)methodology is increasingly present in all areas of modern medicine.In recent years,models based on deep-learning have begun to be used in organ transplantation.Taking into account the huge number of factors and variables involved in donor-recipient(DR)matching,AI models may be well suited to improve organ allocation.AI-based models should provide two solutions:complement decision-making with current metrics based on logistic regression and improve their predictability.Hundreds of classifiers could be used to address this problem.However,not all of them are really useful for D-R pairing.Basically,in the decision to assign a given donor to a candidate in waiting list,a multitude of variables are handled,including donor,recipient,logistic and perioperative variables.Of these last two,some of them can be inferred indirectly from the team’s previous experience.Two groups of AI models have been used in the D-R matching:artificial neural networks(ANN)and random forest(RF).The former mimics the functional architecture of neurons,with input layers and output layers.The algorithms can be uni-or multi-objective.In general,ANNs can be used with large databases,where their generalizability is improved.However,they are models that are very sensitive to the quality of the databases and,in essence,they are black-box models in which all variables are important.Unfortunately,these models do not allow to know safely the weight of each variable.On the other hand,RF builds decision trees and works well with small cohorts.In addition,they can select top variables as with logistic regression.However,they are not useful with large databases,due to the extreme number of decision trees that they would generate,making them impractical.Both ANN and RF allow a successful donor allocation in over 80%of D-R pairing,a number much higher than that obtained with the best statistical metrics such as model for end-stage liver disease,balance of risk score,and survival outcomes following liver transplantation scores.Many barriers need to be overcome before these deeplearning-based models can be included for D-R matching.The main one of them is the resistance of the clinicians to leave their own decision to autonomous computational models.展开更多
BACKGROUND Donor-recipient size mismatch(DRSM)is considered a crucial factor for poor outcomes in liver transplantation(LT)because of complications,such as massive intraoperative blood loss(IBL)and early allograft dys...BACKGROUND Donor-recipient size mismatch(DRSM)is considered a crucial factor for poor outcomes in liver transplantation(LT)because of complications,such as massive intraoperative blood loss(IBL)and early allograft dysfunction(EAD).Liver volumetry is performed routinely in living donor LT,but rarely in deceased donor LT(DDLT),which amplifies the adverse effects of DRSM in DDLT.Due to the various shortcomings of traditional manual liver volumetry and formula methods,a feasible model based on intelligent/interactive qualitative and quantitative analysis-three-dimensional(IQQA-3D)for estimating the degree of DRSM is needed.AIM To identify benefits of IQQA-3D liver volumetry in DDLT and establish an estimation model to guide perioperative management.METHODS We retrospectively determined the accuracy of IQQA-3D liver volumetry for standard total liver volume(TLV)(sTLV)and established an estimation TLV(eTLV)index(eTLVi)model.Receiver operating characteristic(ROC)curves were drawn to detect the optimal cut-off values for predicting massive IBL and EAD in DDLT using donor sTLV to recipient sTLV(called sTLVi).The factors influencing the occurrence of massive IBL and EAD were explored through logistic regression analysis.Finally,the eTLVi model was compared with the sTLVi model through the ROC curve for verification.RESULTS A total of 133 patients were included in the analysis.The Changzheng formula was accurate for calculating donor sTLV(P=0.083)but not for recipient sTLV(P=0.036).Recipient eTLV calculated using IQQA-3D highly matched with recipient sTLV(P=0.221).Alcoholic liver disease,gastrointestinal bleeding,and sTLVi>1.24 were independent risk factors for massive IBL,and drug-induced liver failure was an independent protective factor for massive IBL.Male donor-female recipient combination,model for end-stage liver disease score,sTLVi≤0.85,and sTLVi≥1.32 were independent risk factors for EAD,and viral hepatitis was an independent protective factor for EAD.The overall survival of patients in the 0.85<sTLVi<1.32 group was better compared to the sTLVi≤0.85 group and sTLVi≥1.32 group(P<0.001).There was no statistically significant difference in the area under the curve of the sTLVi model and IQQA-3D eTLVi model in the detection of massive IBL and EAD(all P>0.05).CONCLUSION IQQA-3D eTLVi model has high accuracy in predicting massive IBL and EAD in DDLT.We should follow the guidance of the IQQA-3D eTLVi model in perioperative management.展开更多
AIM To characterize major determinants of 20-year survival after liver transplantation(LT).METHODS This longitudinal single-institution study includes 313 consecutive patients who received a LT between 1988 and 1992. ...AIM To characterize major determinants of 20-year survival after liver transplantation(LT).METHODS This longitudinal single-institution study includes 313 consecutive patients who received a LT between 1988 and 1992. Pretransplant clinical characteristics and laboratory values were assessed and compared between 20-year survivors and non-survivors. Particular attention was paid to the Model for End-Stage Liver Disease(labM ELD)-score and the Eurotransplant Donor Risk Index(ET-DRI) to unravel their impact on 20-year survival after LT.RESULTS Twenty-year survivors were significantly younger(44 vs 50 years, P = 0.001), more likely to be female(49% vs 36%, P = 0.03) and less likely to be obese at the time of LT(19% vs 32%, P = 0.011). Mean labM ELD-score(P = 0.156), rate of high-urgency LT(P = 0.210), coldischemia time(P = 0.994), rate of retransplantation(P = 0.12) and average donor age(28 vs 33 years, P = 0.099) were not statistically different. The mean estimated glomerular filtration rate was higher among survivors(P = 0.007). ET-DRI > 1.4(P = 0.020) and donor age ≥ 30 years(P < 0.022) had significant influence on 20-year survival. The overall survival was not significantly impacted by labM ELD-score categories(P = 0.263).CONCLUSION LT offers excellent long-term results in case of optimal donor and recipient conditions. However, mainly due to the current organ shortage, these ideal circumstances are rarely given; thus algorithms for donor-recipient matching need to be refined, in order to enable a maximum benefit for the recipients of high quality as well as marginal organs.展开更多
Background:The impact of donor-recipient sex-matching patterns on the outcomes of liver transplantation(LT)remains controversial.We aim to compare the long-term graft and recipient survival of LT among four donor-reci...Background:The impact of donor-recipient sex-matching patterns on the outcomes of liver transplantation(LT)remains controversial.We aim to compare the long-term graft and recipient survival of LT among four donor-recipient sex-matching patterns using United Network of Organ Sharing(UNOS)database,and develop a grading system for prognostic stratification.Methods:Adult primary LT recipients from February,2002 to June,2022 in the UNOS database were divided into four donor-recipient sex groups,including female donor-female recipient(F-F)group,female donor-male recipient(F-M)group,male donor-female recipient(M-F)group and male donor-male recipient(M-M)group.Propensity score matching(PSM)analysis,inverse probability treatment weighting and multivariable adjustment were used to minimize between-group imbalances.Univariate and multivariate Cox regression analyses were performed to determine risk factors.Results:A total of 107,183 recipients were included,consisting of 46,037(43.0%)recipients in M-M group,25,699(24.0%)in F-M group,18,340(17.1%)in M-F group and 17,107(15.9%)in F-F group.After PSM,there were significant differences in the graft survival(GS)and overall survival(OS)among four groups(both P<0.001).F-F group showed best prognosis,with 1-,5-and 10-year GS of 89.1%,76.3%and 63.1%,respectively,while F-M group showed poor prognosis,with 1-,5-and 10-year GS of 87.4%,73.6%and 58.4%,respectively.In F-M group,three subgroups with distinctive prognosis were precisely stratified based on a grading system incorporating six independent risk factors.Conclusions:Donor-recipient sex-matching patterns significantly influence long-term LT outcomes.The grading system provides potential value to amend allocation process and optimize organ utility.展开更多
Objective To analyze allele mismatches of HLA-A,-B,-C,-DRB1,-DQB1 and haplotype mismatch of donor-recipient pairs on the outcome of haploidentical transplantation combined with a third part cord blood unit.Methods 230...Objective To analyze allele mismatches of HLA-A,-B,-C,-DRB1,-DQB1 and haplotype mismatch of donor-recipient pairs on the outcome of haploidentical transplantation combined with a third part cord blood unit.Methods 230 pairs of donor-recipient were performed HLA-A,B,C,DRB1,DQB1 typing using展开更多
Background:To investigate the impact of preoperative extracorporeal membrane oxygenation(ECMO)on clinical outcomes in pediatric heart transplantation(PHT).Methods:This retrospective cohort analysis was conducted on 19...Background:To investigate the impact of preoperative extracorporeal membrane oxygenation(ECMO)on clinical outcomes in pediatric heart transplantation(PHT).Methods:This retrospective cohort analysis was conducted on 19 pediatric heart transplant recipients,divided into two groups:ECMO and non-ECMO,based on whether preoperative ECMO was utilized.We evaluated the patients'surgical conditions,postoperative complications,and survival rates.Additionally,the analysis focused on the differences and correlations in clinical characteristics,inflammatory markers,and long-term survival outcomes.Results:There was no statistically significant difference in perioperative survival rates between the ECMO group(85.7%)and the non-ECMO group(83.3%).However,the ECMO group exhibited significantly higher levels of inflammatory markers,including Interleukin-6(IL-6),Interleukin-8(IL-8),Interleukin-6(IL-10),Tumor Necrosis Factor-a(TNF-α),and C-reactive protein(CRP),compared to the non-ECMO group(p<0.05).Notably,IL-6,IL-8,and CRP levels in the ECMO group were found to normalize to the levels of the non-ECMO group 24 h after the operation.The cohort demonstrated a mean donor-recipient weight ratio of 1.38±0.39,with successful cardiac remodeling observed in recipients of oversized grafts,with the highest Donor-RecipientWeight Ratio(DRWR)reaching 3.0.Conclusions:The donor-recipient size mismatch plays a significant role in influencing the success rate of PHT.Despite the inflammatory response and perioperative complications,ECMO proves to be an effective bridging strategy,ultimately enhancing overall outcomes in PHT.展开更多
Achieving optimum outcomes after liver transplantation requires an understanding of the interaction between donor,graft and recipient factors.Within the cohort of patients waiting for a transplant,better matching of t...Achieving optimum outcomes after liver transplantation requires an understanding of the interaction between donor,graft and recipient factors.Within the cohort of patients waiting for a transplant,better matching of the donor organ to the recipient will improve transplant outcomes and benefit the overall waiting list by minimizing graft failure and need for re-transplantation.A PubMed search was conducted to identify published literature investigating the effects of donor factors such as age,gender,ethnicity,viral serology;graft factors such as size and quality,recipient factors such as age,size,gender and transplant factors such as major or minor blood group incompatibility and immunological factors.We also report technical and therapeutic modifications that can be used to manage donor-recipient mismatch identified from literature and the authors’clinical experience.Multiple donor and recipient factors impact graft survival after liver transplantation.Appropriate matching based on donor-organ-recipient variables,modification of surgical technique and innovative peri-transplant strategies can increase the donor pool by utilizing grafts from marginal donors that are traditionally turned down.展开更多
The evolution of liver diseases to end-stage liver disease or to acute hepatic failure, the evaluation process for liver transplantation, the organ allocation decisionmaking, as well as the post-transplant outcomes ar...The evolution of liver diseases to end-stage liver disease or to acute hepatic failure, the evaluation process for liver transplantation, the organ allocation decisionmaking, as well as the post-transplant outcomes are different between female and male genders. Women's access to liver transplantation is hampered by the use of model for end-stage liver disease(MELD) score, in which creatinine values exert a systematic bias against women due to their lower values even in the presence of variable degrees of renal dysfunction. Furthermore, even when correcting MELD score for gender-appropriate creatinine determination, a quantifiable uneven access to transplant prevails, demonstrating that other factors are also involved. While some of the differences can be explained from the epidemiological point of view, hormonal status plays an important role. Moreover, the pre-menopausal and post-menopausal stages imply profound differences in a woman's physiology, including not only the passage from the fertile age to the non-fertile stage, but also the loss of estrogens and their potentially protective role in delaying liver fibrosis progression, amongst others. With menopause, the tendency to gain weight may contribute to the development of or worsening of pre-existing metabolic syndrome. As an increasing number of patients are transplanted for non-alcoholic steatohepatitis, and as the average age at transplant increases, clinicians must be prepared for the management of this particular condition, especially in post-menopausal women, who are at particular risk of developing metabolic complications after menopause.展开更多
This article explores the way in which the World Bank has worked effectively with China in higher education.It investigates whether or not the cooperation between the two has changed in line with their changing relati...This article explores the way in which the World Bank has worked effectively with China in higher education.It investigates whether or not the cooperation between the two has changed in line with their changing relationship.More specifically,it discusses whether the World Bank’s China agenda reflects the reform package of socio-institutional neoliberalism which the World Bank has tended to promote worldwide in the era of the Post-Washington Consensus,and how China’s higher education reform has been influenced by the agenda.The article argues that as China is transferring its role from that of a recipient country to that of a donor country,it is increasingly important to position itself as a global player.Other than mastering the game rules of the international community,China should also expand its influence within and through these major international organizations.展开更多
基金supported by a grant from Mutua Madrile?a XVIII Convovatoria de ayudas a la investigación。
文摘Decision-making based on artificial intelligence(AI)methodology is increasingly present in all areas of modern medicine.In recent years,models based on deep-learning have begun to be used in organ transplantation.Taking into account the huge number of factors and variables involved in donor-recipient(DR)matching,AI models may be well suited to improve organ allocation.AI-based models should provide two solutions:complement decision-making with current metrics based on logistic regression and improve their predictability.Hundreds of classifiers could be used to address this problem.However,not all of them are really useful for D-R pairing.Basically,in the decision to assign a given donor to a candidate in waiting list,a multitude of variables are handled,including donor,recipient,logistic and perioperative variables.Of these last two,some of them can be inferred indirectly from the team’s previous experience.Two groups of AI models have been used in the D-R matching:artificial neural networks(ANN)and random forest(RF).The former mimics the functional architecture of neurons,with input layers and output layers.The algorithms can be uni-or multi-objective.In general,ANNs can be used with large databases,where their generalizability is improved.However,they are models that are very sensitive to the quality of the databases and,in essence,they are black-box models in which all variables are important.Unfortunately,these models do not allow to know safely the weight of each variable.On the other hand,RF builds decision trees and works well with small cohorts.In addition,they can select top variables as with logistic regression.However,they are not useful with large databases,due to the extreme number of decision trees that they would generate,making them impractical.Both ANN and RF allow a successful donor allocation in over 80%of D-R pairing,a number much higher than that obtained with the best statistical metrics such as model for end-stage liver disease,balance of risk score,and survival outcomes following liver transplantation scores.Many barriers need to be overcome before these deeplearning-based models can be included for D-R matching.The main one of them is the resistance of the clinicians to leave their own decision to autonomous computational models.
基金Supported by National Natural Science Foundation of China,No.82172628。
文摘BACKGROUND Donor-recipient size mismatch(DRSM)is considered a crucial factor for poor outcomes in liver transplantation(LT)because of complications,such as massive intraoperative blood loss(IBL)and early allograft dysfunction(EAD).Liver volumetry is performed routinely in living donor LT,but rarely in deceased donor LT(DDLT),which amplifies the adverse effects of DRSM in DDLT.Due to the various shortcomings of traditional manual liver volumetry and formula methods,a feasible model based on intelligent/interactive qualitative and quantitative analysis-three-dimensional(IQQA-3D)for estimating the degree of DRSM is needed.AIM To identify benefits of IQQA-3D liver volumetry in DDLT and establish an estimation model to guide perioperative management.METHODS We retrospectively determined the accuracy of IQQA-3D liver volumetry for standard total liver volume(TLV)(sTLV)and established an estimation TLV(eTLV)index(eTLVi)model.Receiver operating characteristic(ROC)curves were drawn to detect the optimal cut-off values for predicting massive IBL and EAD in DDLT using donor sTLV to recipient sTLV(called sTLVi).The factors influencing the occurrence of massive IBL and EAD were explored through logistic regression analysis.Finally,the eTLVi model was compared with the sTLVi model through the ROC curve for verification.RESULTS A total of 133 patients were included in the analysis.The Changzheng formula was accurate for calculating donor sTLV(P=0.083)but not for recipient sTLV(P=0.036).Recipient eTLV calculated using IQQA-3D highly matched with recipient sTLV(P=0.221).Alcoholic liver disease,gastrointestinal bleeding,and sTLVi>1.24 were independent risk factors for massive IBL,and drug-induced liver failure was an independent protective factor for massive IBL.Male donor-female recipient combination,model for end-stage liver disease score,sTLVi≤0.85,and sTLVi≥1.32 were independent risk factors for EAD,and viral hepatitis was an independent protective factor for EAD.The overall survival of patients in the 0.85<sTLVi<1.32 group was better compared to the sTLVi≤0.85 group and sTLVi≥1.32 group(P<0.001).There was no statistically significant difference in the area under the curve of the sTLVi model and IQQA-3D eTLVi model in the detection of massive IBL and EAD(all P>0.05).CONCLUSION IQQA-3D eTLVi model has high accuracy in predicting massive IBL and EAD in DDLT.We should follow the guidance of the IQQA-3D eTLVi model in perioperative management.
文摘AIM To characterize major determinants of 20-year survival after liver transplantation(LT).METHODS This longitudinal single-institution study includes 313 consecutive patients who received a LT between 1988 and 1992. Pretransplant clinical characteristics and laboratory values were assessed and compared between 20-year survivors and non-survivors. Particular attention was paid to the Model for End-Stage Liver Disease(labM ELD)-score and the Eurotransplant Donor Risk Index(ET-DRI) to unravel their impact on 20-year survival after LT.RESULTS Twenty-year survivors were significantly younger(44 vs 50 years, P = 0.001), more likely to be female(49% vs 36%, P = 0.03) and less likely to be obese at the time of LT(19% vs 32%, P = 0.011). Mean labM ELD-score(P = 0.156), rate of high-urgency LT(P = 0.210), coldischemia time(P = 0.994), rate of retransplantation(P = 0.12) and average donor age(28 vs 33 years, P = 0.099) were not statistically different. The mean estimated glomerular filtration rate was higher among survivors(P = 0.007). ET-DRI > 1.4(P = 0.020) and donor age ≥ 30 years(P < 0.022) had significant influence on 20-year survival. The overall survival was not significantly impacted by labM ELD-score categories(P = 0.263).CONCLUSION LT offers excellent long-term results in case of optimal donor and recipient conditions. However, mainly due to the current organ shortage, these ideal circumstances are rarely given; thus algorithms for donor-recipient matching need to be refined, in order to enable a maximum benefit for the recipients of high quality as well as marginal organs.
基金supported by The National Key Research and Development Program of China(No.2021YFA1100500)Key Research&Development Program of Zhejiang Province(No.2022C03108)+1 种基金Leading Innovation Team of Hangzhou Medical College:Clinical Research in Organ Transplantation(No.CXLJ202401)The Major Research Plan of the National Natural Science Foundation(No.92159202).
文摘Background:The impact of donor-recipient sex-matching patterns on the outcomes of liver transplantation(LT)remains controversial.We aim to compare the long-term graft and recipient survival of LT among four donor-recipient sex-matching patterns using United Network of Organ Sharing(UNOS)database,and develop a grading system for prognostic stratification.Methods:Adult primary LT recipients from February,2002 to June,2022 in the UNOS database were divided into four donor-recipient sex groups,including female donor-female recipient(F-F)group,female donor-male recipient(F-M)group,male donor-female recipient(M-F)group and male donor-male recipient(M-M)group.Propensity score matching(PSM)analysis,inverse probability treatment weighting and multivariable adjustment were used to minimize between-group imbalances.Univariate and multivariate Cox regression analyses were performed to determine risk factors.Results:A total of 107,183 recipients were included,consisting of 46,037(43.0%)recipients in M-M group,25,699(24.0%)in F-M group,18,340(17.1%)in M-F group and 17,107(15.9%)in F-F group.After PSM,there were significant differences in the graft survival(GS)and overall survival(OS)among four groups(both P<0.001).F-F group showed best prognosis,with 1-,5-and 10-year GS of 89.1%,76.3%and 63.1%,respectively,while F-M group showed poor prognosis,with 1-,5-and 10-year GS of 87.4%,73.6%and 58.4%,respectively.In F-M group,three subgroups with distinctive prognosis were precisely stratified based on a grading system incorporating six independent risk factors.Conclusions:Donor-recipient sex-matching patterns significantly influence long-term LT outcomes.The grading system provides potential value to amend allocation process and optimize organ utility.
文摘Objective To analyze allele mismatches of HLA-A,-B,-C,-DRB1,-DQB1 and haplotype mismatch of donor-recipient pairs on the outcome of haploidentical transplantation combined with a third part cord blood unit.Methods 230 pairs of donor-recipient were performed HLA-A,B,C,DRB1,DQB1 typing using
基金supported by National Key Research and Development Program of China(Grant Nos.2021YFC2701700&2021YFC2701703)Special Research Project on Family Planning of the Logistics Support Department of the Military Commission(20JSZ15).
文摘Background:To investigate the impact of preoperative extracorporeal membrane oxygenation(ECMO)on clinical outcomes in pediatric heart transplantation(PHT).Methods:This retrospective cohort analysis was conducted on 19 pediatric heart transplant recipients,divided into two groups:ECMO and non-ECMO,based on whether preoperative ECMO was utilized.We evaluated the patients'surgical conditions,postoperative complications,and survival rates.Additionally,the analysis focused on the differences and correlations in clinical characteristics,inflammatory markers,and long-term survival outcomes.Results:There was no statistically significant difference in perioperative survival rates between the ECMO group(85.7%)and the non-ECMO group(83.3%).However,the ECMO group exhibited significantly higher levels of inflammatory markers,including Interleukin-6(IL-6),Interleukin-8(IL-8),Interleukin-6(IL-10),Tumor Necrosis Factor-a(TNF-α),and C-reactive protein(CRP),compared to the non-ECMO group(p<0.05).Notably,IL-6,IL-8,and CRP levels in the ECMO group were found to normalize to the levels of the non-ECMO group 24 h after the operation.The cohort demonstrated a mean donor-recipient weight ratio of 1.38±0.39,with successful cardiac remodeling observed in recipients of oversized grafts,with the highest Donor-RecipientWeight Ratio(DRWR)reaching 3.0.Conclusions:The donor-recipient size mismatch plays a significant role in influencing the success rate of PHT.Despite the inflammatory response and perioperative complications,ECMO proves to be an effective bridging strategy,ultimately enhancing overall outcomes in PHT.
文摘Achieving optimum outcomes after liver transplantation requires an understanding of the interaction between donor,graft and recipient factors.Within the cohort of patients waiting for a transplant,better matching of the donor organ to the recipient will improve transplant outcomes and benefit the overall waiting list by minimizing graft failure and need for re-transplantation.A PubMed search was conducted to identify published literature investigating the effects of donor factors such as age,gender,ethnicity,viral serology;graft factors such as size and quality,recipient factors such as age,size,gender and transplant factors such as major or minor blood group incompatibility and immunological factors.We also report technical and therapeutic modifications that can be used to manage donor-recipient mismatch identified from literature and the authors’clinical experience.Multiple donor and recipient factors impact graft survival after liver transplantation.Appropriate matching based on donor-organ-recipient variables,modification of surgical technique and innovative peri-transplant strategies can increase the donor pool by utilizing grafts from marginal donors that are traditionally turned down.
文摘The evolution of liver diseases to end-stage liver disease or to acute hepatic failure, the evaluation process for liver transplantation, the organ allocation decisionmaking, as well as the post-transplant outcomes are different between female and male genders. Women's access to liver transplantation is hampered by the use of model for end-stage liver disease(MELD) score, in which creatinine values exert a systematic bias against women due to their lower values even in the presence of variable degrees of renal dysfunction. Furthermore, even when correcting MELD score for gender-appropriate creatinine determination, a quantifiable uneven access to transplant prevails, demonstrating that other factors are also involved. While some of the differences can be explained from the epidemiological point of view, hormonal status plays an important role. Moreover, the pre-menopausal and post-menopausal stages imply profound differences in a woman's physiology, including not only the passage from the fertile age to the non-fertile stage, but also the loss of estrogens and their potentially protective role in delaying liver fibrosis progression, amongst others. With menopause, the tendency to gain weight may contribute to the development of or worsening of pre-existing metabolic syndrome. As an increasing number of patients are transplanted for non-alcoholic steatohepatitis, and as the average age at transplant increases, clinicians must be prepared for the management of this particular condition, especially in post-menopausal women, who are at particular risk of developing metabolic complications after menopause.
基金The author is grateful to Professor Ruth Hayhoe,Professor Mark Bray,and Professor Stephen Heyneman for their insightful viewpoints.
文摘This article explores the way in which the World Bank has worked effectively with China in higher education.It investigates whether or not the cooperation between the two has changed in line with their changing relationship.More specifically,it discusses whether the World Bank’s China agenda reflects the reform package of socio-institutional neoliberalism which the World Bank has tended to promote worldwide in the era of the Post-Washington Consensus,and how China’s higher education reform has been influenced by the agenda.The article argues that as China is transferring its role from that of a recipient country to that of a donor country,it is increasingly important to position itself as a global player.Other than mastering the game rules of the international community,China should also expand its influence within and through these major international organizations.
