Preoperative Alpha-Fetoprotein and Radiological Total Tumor Diameter as Predictors of Hepatocellular Carcinoma Recurrence After Liver Transplantation |
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| Institution: | 1. Faculty of Medicine, University of Brasilia, Campus Universitário Darcy Ribeiro, Brasilia, Federal District, Brazil;2. Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Brasilia, Federal District, Brazil;3. Department of Liver Transplantation, Hospital Brasilia, Brasilia, Federal District, Brazil;1. Laboratory of Immunology and Experimental Transplantation - LITEX, Medical School of Sao Jose do Rio Preto-FAMERP, Sao Jose do Rio Preto, Brazil;2. Kidney Transplant and Dialysis Unit, Hospital de Base-FUNFARME, Sao Jose do Rio Preto, Brazil;1. Liver and Abdominal Organs Transplantation Division, Department of Gastroenterology, Clinics Hospital, University of Sao Paulo Medical School, São Paulo, Brazil;2. Laboratory of Medical Investigation 37, University of Sao Paulo Medical School, Sao Paulo, Brazil;1. Transplantation/Nephrology Division, University Hospital of the Faculty of Medical Science, Belo Horizonte, Minas Gerais, Brazil;2. Epidemiology/Science Health, Governador Israel Pinheiro Hospital/IPSEMG – Belo Horizonte, Minas Gerais, Brazil;3. Surgery Department – Hospital das Clínicas/ Faculty of Medicine Universidade Federal de Minas Gerais – UFMG, Belo Horizonte, Minas Gerais, Brazil;1. Institute of Cardiology and Transplantation of the Federal District (ICTDF), Brasilia, Brazil;2. Department of Liver Transplantation, Hospital Brasilia, Brasilia, Brazil;3. Gastroenterology and Hepatology Unit at Base Hospital, Brasilia, Brazil;4. Specialized Center for Complex Intestinal Diseases, Hospital Brasília, Brazil |
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| Abstract: | BackgroundLiver transplantation is a unique treatment opportunity for patients with chronic liver disease and hepatocellular carcinoma (HCC). Selection of HCC patients for transplantation was revolutionized by Milan-based criteria, but tumor recurrence and shortage of organs are still a major concern. Nowadays, additional preoperative tumor parameters can help to refine the graft allocation process. The objective of this study was to evaluate the prognostic value and cut-off points of pretransplant serum alpha-fetoprotein (AFP) levels and radiological tumor parameters on liver transplantation outcomes.MethodsThis is a single-team retrospective cohort of 162 consecutive deceased donor liver transplants (DDLT) with pathologically confirmed HCC. Pretransplant serum AFP levels and radiological tumor parameters were retrieved from a preoperative follow-up. Receiver-operating characteristics (ROC) curves were used to evaluate cut-off points for each outcome. Multivariate Cox regression model was used to assess the predictors of HCC relapse and recipient mortality.ResultsTwelve recipients (7.4%) had HCC recurrence after transplantation, with median survival time of 5.8 months. Pretransplant AFP ≥30 ng/mL (hazard ratio HR]: 13.84, P = .003) and radiological total tumor diameter (TTD) ≥5 cm (HR: 12.89, P = .005) were independent predictors for HCC relapse. Moreover, pretransplant AFP ≥150 ng/mL was independently associated with recipient mortality (HR: 4.45, P = .003).ConclusionsPretransplant AFP levels and radiological TTD were independently associated with HCC relapse and recipient mortality after DDLT, with different cut-off points predicting different outcomes. These findings may contribute to improving decision-making in the context of liver transplantation for HCC patients. |
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