Preoperative Alpha-Fetoprotein and Radiological Total Tumor Diameter as Predictors of Hepatocellular Carcinoma Recurrence After Liver Transplantation

• Published in: Transplantation proceedings 2022-06, Vol.54 (5), p.1333-1340
• Main Authors: Galdino-Vasconcelos, Mayara Regina, Feijó, Mateus Silva, Ferro, Henrique Metzker, Gomes, Ana Clara Ramalho, De Almeida Santos, Maria Eduarda, Ferreira, Gustavo, Jorge, Fernando, Trevizoli, Natália, Diaz, Luiz Gustavo, De Campos, Priscila Brizolla, Cajá, Gabriel, Ullmann, Raquel, Figueira, Ana Virgínia, Morato, Tiago, Watanabe, André Luís Conde
• Format: Article
• Language: English
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2022.02.065

•Alpha-fetoprotein ≥30 ng/mL and total tumor diameter ≥5 cm were independent predictors of hepatocellular carcinoma (HCC) recurrence.•Alpha fetoprotein ≥150 ng/mL predicted recipients’ overall survival after liver transplantation.•Increasing pretransplant tumor burden was associated with HCC recurrence.•Additional markers can improve decision-making in the context of HCC. Liver 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. This 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. Twelve 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). Pretransplant 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.