Relevance of Pre-Transplant α-fetoprotein Dynamics in Liver Transplantation for Hepatocellular Cancer
Michał Grąt, Maciej Krasnodębski, Waldemar Patkowski, Karolina Maria Wronka, Łukasz Masior, Jan Stypułkowski, Karolina Grąt, Marek Krawczyk
Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
Ann Transplant 2016; 21:115-124
The magnitude of pre-transplant a-fetoprotein (AFP) changes has been advocated to be a superior predictor of hepatocellular cancer (HCC) recurrence following liver transplantation. The aim of this study was to compare AFP dynamics and last pre-transplant AFP as risk factors for post-transplant HCC recurrence.
MATERIAL AND METHODS: Data of 146 patients after liver transplantation for HCC were analyzed retrospectively.
RESULTS: While last pre-transplant AFP was a significant predictor of microvascular invasion (p=0.006) and poor tumor differentiation (p=0.020), AFP slope was associated only with microvascular invasion (p=0.029). Notably, last pre-transplant AFP (p<0.001), but not AFP slope (p=0.279), was an independent risk factor for recurrence. No significant effects of AFP slope were also found following division of patients into those with pre-transplant AFP <100 (p=0.260) and those with AFP >100 (p=0.178) ng/mL. Moreover, prediction of recurrence based on last pre-transplant AFP was superior (p=0.018) to those based on AFP slope. Recurrence-free survival at 5 years was superior in patients with pre-transplant AFP persistently at (97.3%) or dropping to <100 ng/mL (100.0%) as compared to patients with AFP rising to (75.0%) or persistently at >100 ng/mL (38.4%; p<0.001).
CONCLUSIONS: The risk of post-transplant HCC recurrence is dependent on the last pre-transplant AFP regardless of its previous dynamics.
Keywords: alpha-Fetoproteins, Carcinoma, Hepatocellular, Liver Transplantation, Outcome Assessment (Health Care), Recurrence