TY  - JOUR
A1  - Koch, Christine
A1  - Bette, Theresa
A1  - Waidmann, Oliver
A1  - Filmann, Natalie
A1  - Schrecker, Christopher
A1  - Trojan, Jörg
A1  - Weiler, Nina
A1  - Vermehren, Johannes
A1  - Schnitzbauer, Andreas
A1  - Bechstein, Wolf Otto
A1  - Zeuzem, Stefan
A1  - Herrmann, Eva
A1  - Welker, Martin-Walter
T1  - AFP ratio predicts HCC recurrence after liver transplantation
T2  - PLoS one
N2  - Background/aims: Hepatocellular carcinoma (HCC) is a leading indication for liver transplantation (LT) worldwide. Early identification of patients at risk for HCC recurrence is of paramount importance since early treatment of recurrent HCC after LT may be associated with increased survival. We evaluated incidence of and predictors for HCC recurrence, with a focus on the course of AFP levels.
Methods: We performed a retrospective, single-center study of 99 HCC patients who underwent LT between January 28th, 1997 and May 11th, 2016. A multi-stage proportional hazards model with three stages was used to evaluate potential predictive markers, both by univariate and multivariable analysis, for influences on 1) recurrence after transplantation, 2) mortality without HCC recurrence, and 3) mortality after recurrence.
Results: 19/99 HCC patients showed recurrence after LT. Waiting time was not associated with overall HCC recurrence (HR = 1, p = 0.979). Similarly, waiting time did not affect mortality in LT recipients both with (HR = 0.97, p = 0.282) or without (HR = 0.99, p = 0.685) HCC recurrence. Log10-transformed AFP values at the time of LT (HR 1.75, p = 0.023) as well as after LT (HR 2.07, p = 0.037) were significantly associated with recurrence. Median survival in patients with a ratio (AFP at recurrence divided by AFP 3 months before recurrence) of 0.5 was greater than 70 months, as compared to a median of only 8 months in patients with a ratio of 5.
Conclusion: A rise in AFP levels rather than an absolute threshold could help to identify patients at short-term risk for HCC recurrence post LT, which may allow intensification of the surveillance strategy on an individualized basis.
KW  - Hepatocellular carcinoma
KW  - Liver transplantation
KW  - Cancer treatment
KW  - Liver diseases
KW  - Computed axial tomography
KW  - Immune suppression
KW  - Immunology
KW  - Radiation exposure
Y1  - 2020
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/54984
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-549841
SN  - 1932-6203
N1  - Copyright: © 2020 Koch et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
VL  - 15
IS  - (7): e0235576
SP  - 1
EP  - 12
PB  - PLoS
CY  - Lawrence, Kan.
ER  -