The impact of waiting list alpha-fetoprotein changes on the outcome of liver transplant for hepatocellular carcinoma.

Abstract:

BACKGROUND & AIMS:Liver transplantation is a recognized treatment for selected patients with hepatocellular carcinoma (HCC), but transplant criteria still need to be refined, especially in the case of more advanced or downstaged tumors. METHODS:The present study investigated alpha-fetoprotein (AFP) as a predictor of outcome in 6817 patients listed with a diagnosis of HCC in the Scientific Registry of Transplant Recipients. RESULTS:Local pre-transplant HCC treatment was used in 41% of patients on the waiting list. Patients with AFP levels>400 ng/ml at the time of listing who were downstaged to AFP ≤400 ng/ml had better intent-to-treat survival than patients failing to reduce AFP to ≤400 (81% vs. 48% at 3 years, p ≤0.001) and comparable survival to patients with stable AFP ≤400 ng/ml (74%, p = 0.14). Patients with AFP levels decreased ≤400 ng/ml and patients with levels persistently ≤400 ng/ml also had similar drop-out rates from the list (10% in both groups) and post-transplant survival rates (89% vs. 78% at 3 years, p = 0.11). Such an AFP downstaging was associated with good survivals whatever the level of the original AFP (even if originally>1000 ng/ml). Only the last pre-transplant AFP independently predicted survival (p ≤0.001), unlike AFP at listing or AFP changes. CONCLUSIONS:Overall, downstaging HCC patients with high AFP is feasible and leads to similar intent-to-treat and post-transplant survivals to those of patients with AFP persistently low. Only last AFP appears relevant for patient selection before transplantation and should be used in combination with morphological variables.

journal_name

J Hepatol

journal_title

Journal of hepatology

authors

Merani S,Majno P,Kneteman NM,Berney T,Morel P,Mentha G,Toso C

doi

10.1016/j.jhep.2010.12.040

subject

Has Abstract

pub_date

2011-10-01 00:00:00

pages

814-9

issue

4

eissn

0168-8278

issn

1600-0641

pii

S0168-8278(11)00167-X

journal_volume

55

pub_type

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