Pretransplantation α-fetoprotein level as a predictor of hepatocellular carcinoma recurrence after adult living donor liver transplantation within milan criteria in egyptian patients

• Published in: The Egyptian journal of internal medicine 2019-06, Vol.31 (2), p.203-207
• Main Authors: Galal, Magdy, Bahaa, Mohamed, Ibrahim, Wesam A., Elshafie, Ahmed I., Sedrak, Christine R.
• Format: Article
• Language: English
• Subjects: Hepatitis B; hepatocellular carcinoma; histopathology; Internal Medicine; Liver cancer; liver transplantation; Liver transplants; Medicine & Public Health; Original Article; Patients; recurrence; Transplants & implants; α-fetoprotein
• ISSN: 1110-7782; 2090-9098
• DOI: 10.4103/ejim.ejim_106_18

Background and aim of the work Hepatocellular carcinoma (HCC) is the sixth most common cancer in the world and the third most common cause of mortality in patients with cancer. HCC represents one of cirrhosis complications. The aim of this study was to assess pretransplantation α-fetoprotein (AFP) level as a predictor for HCC recurrence after living donor liver transplantation (LDLT). Patients and methods This is a cross-sectional retrospective study for patients with HCC who underwent LDLT and within Milan criteria. Preoperative assessment was performed to assess etiology, operability, and AFP. Locoregional therapy was performed preoperatively as a bridge therapy or for downstaging in patients beyond the Milan criteria. Postoperative abdominal ultrasound and AFP measurement have been performed for HCC recurrence surveillance, as routine investigations. If there is a suspicious lesion of HCC recurrence, triphasic computed tomographic scan is performed and biopsy may be performed. Results Data of 75 patients with HCC who underwent LDLT were analyzed retrospectively. Seventy-three patients were infected with hepatitis C virus; two of them were previously infected with hepatitis B virus, one patient with hepatitis B virus infection, and one patient had hepatitis C virus/hepatitis B virus coinfection. AFP may predict HCC recurrence after LDLT (area under the curve=0.806) at cutoff value of more than 66 ng/ml, with 60% sensitivity, 94.3% specificity, 42.9% positive predictive value, and 97.1% negative predictive value. Conclusion Preoperative serum AFP level may predict post-transplant HCC recurrence. It may be used in combination with other factors to create a prognostic model that may predict HCC recurrence after liver transplantation.