AFP ratio predicts HCC recurrence after liver transplantation

  • 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.
Author:Christine KochORCiD, Theresa Bette, Oliver WaidmannORCiDGND, Natalie FilmannORCiDGND, Christopher Schrecker, Jörg TrojanORCiDGND, Nina Weiler, Johannes VermehrenGND, Andreas SchnitzbauerORCiDGND, Wolf Otto BechsteinORCiDGND, Stefan ZeuzemORCiDGND, Eva HerrmannORCiDGND, Martin-Walter WelkerGND
Pubmed Id:
Parent Title (English):PLoS one
Place of publication:Lawrence, Kan.
Contributor(s):Gianfranco Alpini
Document Type:Article
Year of Completion:2020
Date of first Publication:2020/07/02
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2020/07/06
Tag:Cancer treatment; Computed axial tomography; Hepatocellular carcinoma; Immune suppression; Immunology; Liver diseases; Liver transplantation; Radiation exposure
Issue:(7): e0235576
Page Number:12
First Page:1
Last Page:12
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.
Institutes:Medizin / Medizin
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (German):License LogoCreative Commons - Namensnennung 4.0