Non-volatile transistor memory devices using charge storage cross-linked core-shell nanoparticles.

Solution processable cross-linked core-shell poly[poly(ethylene glycol)methylether methacrylate]-block-poly(2,5-dibromo-3-vinylthiophene) (poly(PEGMA)m-b-poly(DB3VT)n) nanoparticles are firstly explored as charge storage materials for transistor-type memory devices owing to their efficient and controllable ability in electric charge transfer and trapping.

Catheter-directed continuous thrombolysis following aspiration thrombectomy via the ileocolic route for acute portal venous thrombosis: report of two cases.

Although acute portal venous thrombosis (PVT) is a potentially life-threatening complication that occurs after hepatobiliary surgery with portal vein (PV) reconstruction or splenectomy, no effective or universal treatments have yet been established. Transjugular or transhepatic catheter-directed thrombolysis has recently been reported to be effective for treating acute PVT. However, the efficiency of this treatment for complete PV occlusion might be limited because a poor portal venous flow prevents thrombolytic agents from reaching and dissolving thrombi. Moreover, the use of the transjugular or transhepatic route might not be suitable in patients who have undergone major hepatectomy or in those with ascites due to an increased risk of residual liver injury or intra-abdominal bleeding following puncture to the residual liver. We herein describe the cases of two patients with almost total PV occlusion caused by massive thrombi that formed after hepatobiliary surgery, who were successfully treated with catheter-directed continuous thrombolysis following aspiration thrombectomy via the ileocolic route. This treatment should be considered beneficial for treating selected patients such as the two patients described herein.

Successful laparoscopic division of a patent ductus venosus: report of a case.

Patent ductus venosus (PDV) is a rare condition of a congenital portosystemic shunt from the umbilical vein to the inferior vena cava. This report presents the case of an adult patient with PDV, who was successfully treated with laparoscopic shunt division. A 69-year-old male was referred with hepatic encephalopathy. Contrast-enhanced CT revealed a large connection between the left portal vein and the inferior vena cava, which was diagnosed as PDV. The safety of a shunt disconnection was confirmed using a temporary balloon occlusion test for the shunt, and the shunt division was performed laparoscopically. The shunt was carefully separated from the liver parenchyma with relative ease, and then divided using a vascular stapler. Portal flow was markedly increased after the operation, and the liver function of the patient improved over the 3-month period after surgery. Although careful interventional evaluation for portal flow is absolutely imperative prior to surgery, a minimally invasive laparoscopic approach can be safely used for treating PDV.

Perioperative immunological differentiation in liver cirrhotic patients who underwent living related liver transplantation.

BACKGROUND/AIMS: Liver cirrhotic patients are immunological compromised hosts. Preoperative status in cirrhotic patients affects postoperative infection complications. This study investigates the perioperative immunological changes in the differentiation by MELD score. METHODOLOGY: Fifteen patients underwent LDLT and were divided two groups, Group I (n=5, MELD score >=20) and Group II (n=10, MELD score <20). Immunological status of cirrhotic patients was analyzed for Th1, Th2, Treg and Th17 by flow cytometry using monoclonal antibody CD3/CD19,CD4/8, FoxP3, IL-17, IFN-γ and TNF-α. RESULTS: T cell decreased and increased gradually following LDLT. The preoperative T cell count of MELD score 33 patients was very low. CD4 and CD8 T cells also decreased after LDLT. The preoperative CD8+ T cell count of MELD score 33 patients was very low. Th17 decreased and recovered gradually in the all patients after LDLT. However Th17 of MELD score 33 did not recover. IFN-γ-producing cells in naive T cells decreased after LDLT. Preoperatively those in the Group I was lower than those in the Group II. The population of Treg decreased in the Group I, however, it increased in the Group II on 7 days after LDLT. CONCLUSIONS: The patients with MELD score >20 showed a decrease of cytotoxic immunity with both diminution and delay of CD8+ T cells and Th17 helper T cells. The cytotoxic immunity of the patients with MELD score <20 was maintained and recovered in the early period after LDLT. The patients with MELD score >20 might be at high risk of infection after LDLT.

Heterotopic pancreas autotransplantation with spleen for uncontrollable hemorrhagic pseudocyst and disabling pain in chronic pancreatitis.

BACKGROUND/AIMS: In this study, we report on a heterotopic segmental pancreatic autotransplantation (HPAT) with spleen for alcoholic chronic pancreatitis with uncontrollable hemorrhagic pseudocyst and complete portal venous obstruction. The patient was a 72-year-old man who had an alcoholic chronic pancreatitis with severe abdominal pain and hemorrhagic pseudocyst. The first bleeding from a pseudoaneurism of the gastro-duodenal artery (GDA) to the cyst of pancreas head was stopped by interventional radiology (IVR) at our hospital on May 2010. The second bleeding happened with severe abdominal pain on February 15th, 2011; he was admitted on February 17. The IVR was not successful. METHODOLOGY: There were two problems for the operation. The first was the severe inflammation and the second was the control of hemorrhage from GDA. We were afraid of the postoperative hemorrhage due to the leakage of pancreatic juice in the pancreato-duodenectomy (PD). Therefore, we chose the HPAT as a solution for postoperative hemorrhage and severe abdominal pain. After complete duodeno-pancreatectomy with spleen, we performed HPAT with spleen on March 8, 2011. The pancreatic duct reconstruction was performed by Roux-en-Y anastomosis to the jejunum. RESULTS: The postoperative course was uneventful. The abdominal pain had resolved completely and the patient remained normoglycemic after HPAT. CONCLUSIONS: We conclude that HPAT is a useful option for hemorrhagic pseudocyst of the pancreas head with severe abdominal pain of chronic pancreatitis.

A new technique of lateral approach for laparoscopy-assisted donor left hepatectomy.

This report describes laparoscopy-assisted donor left hepatectomy preserving the caudate lobe (LADLH), and a new technique for hand-assisted liver transection between the left lobe and the caudate lobe beforehand, called the 'lateral approach.' Four donor patients underwent LADLH. Preoperative computed tomography investigated the depth and width between the left lobe and the caudate lobe from the Arantius duct. LADLH was performed through a 9cm midline epigastric hand-port incision with four ports. The confluence of the middle and left hepatic veins was encircled with tape. Hand-assisted liver transection between the left lobe and the caudate lobe was performed using laparosonic coagulating shears after precoagulation with radio frequency ablation under ultrasonographic guidance. Through the hand-port incision, the tape around the middle and left hepatic veins could be passed between the left lobe and the caudate lobe to the porta hepatis. We used the tape toward the end of the parenchymal transection to bring the transection plane closer to the surface. The liver parenchyma was divided at Cantlie's line under direct vision. The graft was extracted through the hand-port incision. All donors underwent LADLH completely without any intraoperative complication. None of the donors required transfusion or re-operation.

Clinical and cardiac features of patients with subarachnoid haemorrhage presenting with out-of-hospital cardiac arrest.

BACKGROUND: Subarachnoid haemorrhage (SAH) is known as one of the aetiologies of out-of-hospital cardiac arrest (OHCA). However, the mechanisms of circulatory collapse in these patients have remained unclear. METHODS AND RESULTS: We examined 244 consecutive OHCA patients transferred to our emergency department. Head computed tomography was performed on all patients and revealed the existence of SAH in 14 patients (5.9%, 10 females). Among these, sudden collapse was witnessed in 7 patients (50%). On their initial cardiac rhythm, all 14 patients showed asystole or pulseless electrical activity, but no ventricular fibrillation (VF). Return of spontaneous circulation (ROSC) was obtained in 10 of the 14 patients (14.9% of all ROSC patients) although all resuscitated patients died later. The ROSC rate in patients with SAH (71%) was significantly higher than that of patients with either other types of intracranial haemorrhage (25%, n=2/8) or presumed cardiovascular aetiologies (22%, n=23/101) (p<0.01). On electrocardiograms, ST-T abnormalities and/or QT prolongation were found in all 10 resuscitated patients. Despite their electrocardiographic abnormalities, only 3 patients showed echocardiographic abnormalities. CONCLUSIONS: The frequency of SAH in patients with all causes of OHCA was about 6%, and in resuscitated patients was about 15%. The initial cardiac rhythm revealed no VF even though half had a witnessed arrest. A high ROSC rate was observed in patients with SAH, although none survived to hospital discharge.

A 10-year experience of shunt surgery for esophago-gastric varices in a single center in Japan.

BACKGROUND/AIMS: We report 10 years' experience of shunt surgeries, and in particular Inokuchi shunt operation, at a single Japanese center. METHODOLOGY: Subjects were 50 patients who underwent shunt surgery, including Inokuchi shunt, distal splenorenal shunt, H-graft shunt, and inferior mesenteric venous-left renal vein shunt from November 1997 to November 2007. These patients were divided into two groups, a selective shunt group and a non-selective shunt group. RESULTS: Surgical duration was significantly longer in the selective group than in the non-selective group (p<0.0001). Blood loss was also significantly larger in the non-selective group (p=0.012). Pre-portal venous pressure did not change significantly after shunting in the selective shunt group. On the other hand, it decreased significantly from 378 +/- 39.7 mmH2O to 246 +/- 56.0 mmH2O (p<0.0001) in the non-selective group. The 2 and 5 year patency rates were 87% and 68%, respectively, in the selective shunt group, and 87% and 87% in the non-selective shunt group. CONCLUSIONS: Our data on survival rate and shunt patency for Inokchi shunt are similar to those originally reported by Inokuchi in 1984. The consecutive experiences of shunt operation in a single center were important for the improvement of surgical skills, both of the individual surgeon and the team.

Method for spontaneous constriction and closure of portocaval shunt using a ligamentum teres hepatis in small-for-size graft liver transplantation.

BACKGROUND: We have developed a new portocaval (PC) shunt creation technique for use in small-for-size (SFS) graft liver transplantations. PC shunts are already used to avoid SFS graft syndrome in cases of adult-to-adult living donor liver transplantation (LDLT), but the current method of creating these shunts is subject to two problems: reportal hypertension and liver dysfunction after premature ligation of the PC shunt; and graft atrophy and liver dysfunction because of the loss of portal venous flow late in the recovery period after LDLT. METHODS: Our new technique avoids these two problems simultaneously by using the interposed obliterated ligamentum teres hepatis (LTH) to create the PC shunt, then obstructing the PC shunt after regeneration of the liver graft. RESULTS: We have used this technique in four cases. In all cases, portal venous pressures after shunting were lower than those before shunting, and PC shunts with lower portal pressure were obstructed faster than that with higher portal pressure. CONCLUSION: Our results suggest that the LTH can function as a shape memory graft to reduce portal venous flow after regeneration of the graft liver. Using the LTH to create a PC shunt might help to prevent both SFS graft syndrome early in the recovery period after LDLT and loss of portal venous flow late in the recovery period.

A patient with severe hypercalcemia in multiple organ dysfunction syndrome: role of elevated circulating 1alpha,25(OH)2 vitamin D levels.

A 54-year-old man was transferred to our ICU because of systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS). He died after 38 days of intensive care. During treatment, his serum calcium (Ca) levels continued to increase and reached 3.95 mmol/L, while the ionized Ca levels reached 2.30 mmol/L before his death. He presented with severe kidney injury, pancreatitis, and hemorrhagic gastric erosion that worsened his prognosis; these were possibly associated with the hypercalcemia. His circulating 1alpha,25-dihydroxyvitamin D [1,25(OH)(2)D] level was elevated (75.7 to 204 pg/mL), whereas the levels of 25-hydroxyvitamin D, parathyroid hormone, and parathyroid hormone-related peptide were not. Liver histology revealed immunoreactivity for 25-hydroxyvitamin D 1alpha-hydroxylase (CYP27B1) in some of the hepatocytes, in which the localization pattern was similar to that of lysozyme-positive hepatocytes. Our ICU has previously encountered 22 similar MODS patients who presented with hypercalcemia over the last 8 years. SIRS with severe kidney and liver injuries are common clinical findings in hypercalcemic patients with MODS. Of the 23 hypercalcemic MODS patients, including the present patient, 17 had circulating 1,25(OH)(2)D levels exceeding 70 pg/mL despite severe kidney injury. Extrarenal activation of CYP27B1 seems to play a role in the development of hypercalcemia in this disease condition. Clinicians need to be aware that severe hypercalcemia may occur in MODS patients.

Intra portal donor specific antigen transfusion might prevent re-infection of hepatitis C virus after living related liver transplantation in hepatitis C hepatic cirrhosis.

BACKGROUND/AIMS: Re-infection of hepatitis C virus (HCV) is very important for prognosis after liver transplantation of HCV cirrhosis. In the mechanism of re-infection of HCV, the peri-transplant immunity including the immunosuppression must be very important for getting the solution of prevention of its infection. (please rewrite this phrase). In this study, we investigated the influences of intraportal DST for HCV-reinfection after living related liver transplantation (LRLT). METHODOLOGY: The 12 patients, who underwent LRLT for the end-stage HCV liver cirrhosis from 1999 to 2007 in our hospital, were estimated about the influence of intraportal DST for re-infection of HCV. The nine persons of all patients had received the intraportal DST after LRLT. RESULTS: These nine patients could be steroid withdrawn within 2 months. The seven persons of all patients that received intraportal DST were treated with perioperative IFN therapy. Two patients had preoperative interferon-beta therapy. The one patient could obtain SVR. The other patient dropped out for the complications. The four patients had interferon-beta therapy in the acute hepatitis phase. Two patients had it in the chronic hepatitis phase. The one patient mentioned before, had preoperative IFN-beta and dropped out. HCV of the one patients without interferon therapy disappeared spontaneously from 3 months. The HCV disappeared in the 6 patients (66.7%) of all nine patients with intraportal DST after LRLT. The five of six patients were SVR. The patient who got preoperative IFN-beta revealed the macrochimerism of donor type CD56+T cell in the graft liver one month after LRLT. The immunological analysis about the patient, who got a spontaneous disappearance of HCV two months after LRLT, demonstrated that CD56+T cells strongly developed the both FasL and TRAIL expressions. CONCLUSION: In this study, the clinical and immunological findings suggested that intraportal DST might affect for the clearance of HCV by the both host immunity and IFN-ribavirin therapy.

A complete physiological orthotopic living related partial pancreatic transplantation alone with pancreatic duct to duct anastomosis for type I diabetes mellitus.

In this study, we reported a complete solitary living related orthotopic partial pancreatic transplantation (LROPPT) with duct to duct drainage of pancreatic juice. A 29-year old man, who has suffered from type I diabetes mellitus (DM) since age 2, underwent LROPPT on 2007 August 9th. He had hypoglycemia for several times per week. His preoperative hemoglobin A1c (HbA1c) was 8.4%. He has little diabetic complications of 2 degree of nephropathy with albuminuria and slight neuropathy. The donor was a 57-year old his father, whose preoperative 75gOGTT and ivGTT revealed normal pattern. Donor was performed hand-assisted distal pancreatectomy with spleen. Operative time was 5 hours and 18 min and intraoperative hemorrhage was 75 ml. Recipient was explored by upper abdominal L-shaped incision. Distal pancreatectomy with spleen with enough expose of both splenic vein and artery, and main pancreatic duct. Both the splenic vein and the arterial anastomosis was made, thereafter, pancreatic duct to duct anastomosis was made by 6-0 PDS with pancreatic duct stent. The pancreatic duct stent lead to extra abdomen through Papilla Vater and duodenum. Pancreatic tissue was anastomosis by 6-0 prolene using fibrin-glue. After that, absorbed thin mesh was rolled around the pancreatic anastomosis with fibrin-glue. The operative time was 10 hr 10 min and the blood loss was 435 ml. Patient was discharged without a pancreatic leakage and vessel thrombosis 16th days after transplantation. LROPPT is a complete physiologic procedure. In Japan, almost of donor is marginal donor aged above 50 years old. The portal drainage might be comfortable for the stress of the partial pancreatic graft.

Lunar radar sounder observations of subsurface layers under the nearside maria of the Moon.

Observations of the subsurface geology of the Moon help advance our understanding of lunar origin and evolution. Radar sounding from the Kaguya spacecraft has revealed subsurface layers at an apparent depth of several hundred meters in nearside maria. Comparison with the surface geology in the Serenitatis basin implies that the prominent echoes are probably from buried regolith layers accumulated during the depositional hiatus of mare basalts. The stratification indicates a tectonic quiescence between 3.55 and 2.84 billion years ago; mare ridges were formed subsequently. The basalts that accumulated during this quiet period have a total thickness of only a few hundred meters. These observations suggest that mascon loading did not produce the tectonics in Serenitatis after 3.55 billion years ago. Global cooling probably dominated the tectonics after 2.84 billion years ago.

Splenic-intrahepatic left portal shunt in an adult patient with extrahepatic portal vein obstruction without recurrence after pancreaticoduodenectomy.

In the last decade, a superior mesenteric-intrahepatic left portal shunt (Rex shunt) has been reported for successful management of extrahepatic portal vein obstruction in children. However, in adults, a mesocaval shunt has been generally performed for the surgical management of extrahepatic portal vein obstruction because of the complexity of the underlying disease and the difficulty of the superior mesenteric-intrahepatic left portal shunt. We herein report an adult patient who was successfully treated by splenic-intrahepatic left portal shunt with an artificial graft (6-mm polytetrafluoroethylene) for complete obstruction of the extrahepatic portal vein following pancreaticoduodenectomy. The shunt procedure not only relieved portal hypertension but also restored hepatic portal flow. In the near future, the Rex shunt should be considered for a beneficial management of extrahepatic portal vein obstruction, even in adults.

Risk factors and prevention of biliary anastomotic complications in adult living donor liver transplantation.

AIM: To evaluate risk factors of biliary anastomotic complications (BACs) and outcomes according to type of biliary reconstruction. METHODS: A total of 33 consecutive adult living donor liver transplantation (LDLT) were reviewed, 17 of which had undergone Duct-to-Duct anastomosis (D-D). The remaining 16 patients received Roux-en-Y anastomosis (R-Y). The perioperative factors, such as the type of graft and the number of graft bile ducts, were analyzed retrospectively. RESULTS: The overall incidence of BACs was 39.4%. The incidence of BACs was significantly higher in the patients with than without neoadjuvant chemotherapy (71.4% vs 10%, P = 0.050). There was no significant difference in the incidence of biliary leakage in patients with D-D vs those with R-Y. The incidence of biliary strictures following the healing of biliary leakage was significantly higher in D-D (60%) than in R-Y (0%) (P = 0.026). However, the incidence of BACs related bacteremia was significantly higher in R-Y than in D-D (71.4% vs 0%, P = 0.008). In D-D, use of T-tube stent remarkably reduced the incidence of BACs, compared with straight tube stent (0% vs 50%, P = 0.049). CONCLUSION: Our experience showed an increase of BACs related bacteremia in the patients with R-Y. Therefore, D-D might be a preferred biliary reconstruction. However, the surgical refinement of D-D should be required because of the high incidence of biliary strictures. Use of the T-tube stent might lead to a significant reduction of BACs in D-D.

Beneficial effect of partial portal decompression using the inferior mesenteric vein for intractable gastroesophageal variceal bleeding in patients with liver cirrhosis.

BACKGROUND: Use of the inferior mesenteric vein (IMV) for partial portal decompression has not been recommended as a first-line option for intractable gastroesophageal variceal bleeding because of the thin diameter of the vein. Although these indications remain relevant, few reports have compared partial portal decompression using the IMV with other therapies. We propose that partial portal decompression using the IMV is a useful alternative treatment for intractable variceal bleeding. METHODS: We performed partial portal decompression using the IMV in eight patients with intractable variceal bleeding that had been uncontrolled using medical and endoscopic therapies. All patients were classified into Child's class B or C. The surgical data, morbidity, and mortality were assessed. RESULTS: Mean portal venous pressure significantly decreased from 26.9 +/- 2.0 mmHg before the surgery to 19.8 +/- 3.9 mmHg after the surgery. The operative mortality rate was 0%. The mean duration of hospital stay was 25.5 +/- 13.3 days. Although one patient experienced recurrent bleeding, shunt patency was well maintained in all patients during the follow-up period (mean 28.9 +/- 14.1 months). Six patients are still alive and well without ascites or hepatic encephalopathy. Two of the Child's class C patients who underwent emergency shunt died owing to hepatic decompensation. CONCLUSION: Partial portal decompression using the IMV can be a safe, effective way to treat intractable variceal bleeding in patients with liver cirrhosis. However, use of the shunt procedure may have the most survival benefits for cirrhotic patients with preserved liver function.

Characteristics of biliary reconstruction, using a T-tube, as compared to those with other methods, in left-lobe adult living-donor liver transplantation.

BACKGROUND/PURPOSE: Postoperative biliary tract complications remain one of the most serious problems facing patients who undergo living-donor liver transplantation. The aim of this study was to analyze the clinical implications of three different methods of biliary reconstruction in left-lobe adult living-donor liver transplantation. METHODS: We retrospectively compared three groups of patients: those who had Roux-en-Y hepaticojejunostomy (HJ; n = 11) biliary reconstruction, those who had duct-to-duct hepaticohepaticostomy (HH) with external stent (n = 11), and those who had HH with a T-tube (n = 6). Median follow-up for each group was 31, 30, and 10 months, respectively. RESULTS: Bile leaks were observed in 45.5% of the patients in both the HJ group and the HH with external stent group. Biliary anastomotic strictures occurred in 9% of the Roux-en-Y HJ patients and in 27.2% of those who had HH with external stent. No biliary complications were observed in the HH with a T-tube group (P = 0.049). CONCLUSIONS: Biliary reconstruction using HH with a T-tube may decrease the incidence of biliary complications. Despite the relatively short follow-up period, these encouraging preliminary results may warrant further studies of this biliary reconstruction technique in left-lobe adult living-donor liver transplantation.

Video-assisted living donor hemihepatectomy through a 12-cm incision for adult-to-adult liver transplantation.

OBJECTIVES: There has been remarkable progress in recent technical innovations for laparoscopic hepatectomy. However, a laparoscopic procedure rarely has been indicated for donation of the liver in living-related liver transplantation (LRLT). Here, we described the technique and the outcome of video-assisted donor hepatectomy (VADH) for adult-to-adult LRLT. METHODS: For 13 donors in adult-to-adult LRLT, 3 types of major hepatectomy--right hemihepatectomy (3), and left hemihepatectomy, with or without the caudate lobe (10)--were performed through video-assisted procedures; surgical manipulation via ports or via a 12-cm incision and viewing through a laparoscope or through incision were combined and used. RESULTS: VADH was completed in 13 donors, with a median operation time of 363 +/- 33 minutes and a median blood loss of 302 +/- 191 mL. No complications specific to video-assisted procedures, postoperative bile leak, or bleeding were observed. The restoration of the liver function was smooth, and the use of an analgesic (median: 1.2 times) was reduced, compared with the historical control (median: 3.8 times) that underwent a standard donation of the liver. Currently, all donors are healthy and have returned to their previous activities. The grafts have been functioning well, excluding 3 recipients who succumbed to serious complications unrelated to the video-assisted procedure. CONCLUSION: We have shown a new method of VADH through a 12-cm laparotomy for adult-to-adult LRLT. This technique is as feasible as standard open donor hepatectomy, with less pain and with improved postoperative symptoms.

A case of cervical spondylitis during stellate ganglion block.

We report a case of cervical spondylitis that developed during treatment with a series of stellate ganglion blocks. A 65-year-old man was scheduled for 10 sessions of stellate ganglion block for treatment of right-sided deafness of sudden onset due to Ramsay Hunt syndrome. Administration of betamethasone was started 5 days before the first block and was continued for 6 weeks. After disinfection of the skin by povidone iodine, each stellate ganglion block was performed via the paratracheal approach. The first four block sessions were uneventful. However, during the fifth session, the patient complained of neck pain. After 10 sessions, the deafness improved and the patient was discharged from the hospital. Three weeks after discharge, he was readmitted for sustained neck and bilateral shoulder pain and numbness of the right hand. Cervical roentgenography and magnetic resonance imaging revealed spondylitis of C5 and C6. Antibiotics were administered for 2 weeks. The inflammatory variables on blood examination improved, but cervical roentgenography performed 8 weeks after the last block showed that the vertebral body of C6 was nearly completely destroyed. Four months after the last block, the vertebral bodies of C5 and C6 had fused. This case indicates that when stellate ganglion block is performed in patients who are taking a corticosteroid, the disinfection procedure must be strictly followed and that if the patient complains of neck or shoulder pain, cervical roentgenography or magnetic resonance imaging or both should be immediately performed to assess the presence of spondylitis.

Preoperative human-telomerase reverse transcriptase mRNA in peripheral blood and tumor recurrence in living-related liver transplantation for hepatocellular carcinoma.

BACKGROUND/AIMS: In this study we evaluated the potential role of preoperative h-TERT mRNA expression in peripheral blood as a tool for predicting prognosis and tumor recurrence after living-related liver donor transplantation (LRLDT). METHODOLOGY: The study included patients with unresectable HCC who underwent LRLDT from July 1999 to May 2003. RESULTS: There was no significant difference between the survival curves of those patients who met the Milan criteria and those who did not. However, there was a statistically significant difference (p=0.032) between the survival curves of those patients with positive preoperative h-TERT mRNA expression, and those who either had an initially negative preoperative h-TERT mRNA or who converted from positive to negative after neoadjuvant immunochemotherapy. CONCLUSIONS: In conclusion, the presence or absence of h-TERT mRNA in the peripheral blood may be a useful criterion in evaluating HCC patients for transplantation, as well as a valuable method of assessing anti-tumor therapy and tumor relapse.