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


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.


J Hepatol


Journal of hepatology


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




Has Abstract


2011-10-01 00:00:00














  • Ultrarapid hepatitis C virus clearance by daily high-dose interferon in non-responders to standard therapy.

    abstract:BACKGROUND/AIMS:To analyze the kinetics of the hepatitis C virus and the patterns of resistance to interferon alpha, we assessed HCV RNA levels early during retreatment with high-dose interferon in patients who did not respond to standard treatment. METHODS:Eleven non-responders to previous therapy with 3-6 MU interfe...

    journal_title:Journal of hepatology

    pub_type: 临床试验,杂志文章


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  • Birth cohort-specific disparities in hepatocellular carcinoma stage at diagnosis, treatment, and long-term survival.

    abstract:BACKGROUND & AIMS:Individuals born between 1945 and 1965 account for nearly 75% of hepatitis C virus (HCV) infections in the United States. As this cohort ages, progressive HCV-related liver disease leading to cirrhosis and hepatocellular carcinoma (HCC) will place a significant burden on the healthcare system. We aim ...

    journal_title:Journal of hepatology

    pub_type: 杂志文章


    authors: Yan M,Ha J,Aguilar M,Bhuket T,Liu B,Gish RG,Cheung R,Wong RJ

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  • Impaired liver regeneration in Ldlr-/- mice is associated with an altered hepatic profile of cytokines, growth factors, and lipids.

    abstract:BACKGROUND & AIMS:It is widely recognized that in the early stages of liver regeneration after partial hepatectomy, the hepatocytes accumulate a significant amount of lipids. The functional meaning of this transient steatosis and its effect on hepatocellular proliferation are not well defined. In addition, the basic me...

    journal_title:Journal of hepatology

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  • Treatment of concanavalin A-induced hepatitis in mice with low molecular weight heparin.

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  • Histological and virological features and follow-up of hepatitis C virus carriers with normal aminotransferase levels: the Italian prospective study of the asymptomatic C carriers (ISACC).

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    journal_title:Journal of hepatology

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  • Notch signaling regulates tubular morphogenesis during repair from biliary damage in mice.

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    journal_title:Journal of hepatology

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    journal_title:Journal of hepatology

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  • Nicardipine increases hepatic blood flow and the hepatic clearance of indocyanine green in patients with cirrhosis.

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    journal_title:Journal of hepatology

    pub_type: 临床试验,杂志文章,随机对照试验


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  • Minimization of hepatitis B infection by a 25-year universal vaccination program.

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    journal_title:Journal of hepatology

    pub_type: 杂志文章


    authors: Ni YH,Chang MH,Wu JF,Hsu HY,Chen HL,Chen DS

    更新日期:2012-10-01 00:00:00

  • The clinical significance of persistently normal ALT in chronic hepatitis B infection.

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    journal_title:Journal of hepatology

    pub_type: 临床试验,杂志文章


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    journal_title:Journal of hepatology

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    journal_title:Journal of hepatology

    pub_type: 杂志文章


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    pub_type: 杂志文章


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    journal_title:Journal of hepatology

    pub_type: 杂志文章


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    更新日期:2015-06-01 00:00:00

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    pub_type: 杂志文章


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    journal_title:Journal of hepatology

    pub_type: 杂志文章,评审


    authors: Imrie D,Sadler KC

    更新日期:2012-11-01 00:00:00

  • Endoscopic ultrasonography classification of gastric varices in patients with cirrhosis. Comparison with endoscopic findings.

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    journal_title:Journal of hepatology

    pub_type: 杂志文章


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    更新日期:1993-09-01 00:00:00

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    journal_title:Journal of hepatology

    pub_type: 社论


    authors: Seeger C,Mason WS

    更新日期:2016-04-01 00:00:00

  • p53 haploinsufficiency and increased mTOR signalling define a subset of aggressive hepatocellular carcinoma.

    abstract:BACKGROUND & AIMS:p53 mutations occur frequently in human HCC. Activation of the mammalian target of rapamycin (mTOR) pathway is also associated with HCC. However, it is still unknown whether these changes together initiate HCC and can be targeted as a potential therapeutic strategy. METHODS:We generated mouse models ...

    journal_title:Journal of hepatology

    pub_type: 杂志文章


    authors: Luo YD,Fang L,Yu HQ,Zhang J,Lin XT,Liu XY,Wu D,Li GX,Huang D,Zhang YJ,Chen S,Jiang Y,Shuai L,He Y,Zhang LD,Bie P,Xie CM

    更新日期:2021-01-01 00:00:00

  • Hepatitis B virus and human immunodeficiency virus drugs in pregnancy: findings from the Antiretroviral Pregnancy Registry.

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    journal_title:Journal of hepatology

    pub_type: 杂志文章


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    更新日期:2012-11-01 00:00:00

  • Management of anemia induced by triple therapy in patients with chronic hepatitis C: challenges, opportunities and recommendations.

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    journal_title:Journal of hepatology

    pub_type: 杂志文章,评审


    authors: Romero-Gómez M,Berenguer M,Molina E,Calleja JL

    更新日期:2013-12-01 00:00:00

  • Mouse hepatocytes and LSEC proteome reveal novel mechanisms of ischemia/reperfusion damage and protection by A2aR stimulation.

    abstract:BACKGROUND & AIMS:Ischemia-reperfusion (IR) of liver results in hepatocytes (HP) and sinusoidal endothelial cells (LSEC) irreversible damage. Ischemic preconditioning protects IR damage upon adenosine A2a receptor (A2aR) stimulation. Understanding the phenotypic changes that underlie hepatocellular damage and protectio...

    journal_title:Journal of hepatology

    pub_type: 杂志文章


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    更新日期:2015-03-01 00:00:00

  • Mutations in DCDC2 (doublecortin domain containing protein 2) in neonatal sclerosing cholangitis.

    abstract:BACKGROUND & AIMS:Neonatal sclerosing cholangitis (NSC) is a severe neonatal-onset cholangiopathy commonly leading to liver transplantation (LT) for end-stage liver disease in childhood. Liver biopsy findings histopathologically resemble those in biliary atresia (BA); however, in NSC extrahepatic bile ducts are patent,...

    journal_title:Journal of hepatology

    pub_type: 杂志文章


    authors: Grammatikopoulos T,Sambrotta M,Strautnieks S,Foskett P,Knisely AS,Wagner B,Deheragoda M,Starling C,Mieli-Vergani G,Smith J,University of Washington Center for Mendelian Genomics.,Bull L,Thompson RJ

    更新日期:2016-12-01 00:00:00

  • Inherited non-alcoholic fatty liver disease and dyslipidemia due to monoallelic ABHD5 mutations.

    abstract:BACKGROUND & AIMS:Non-alcoholic fatty liver disease (NAFLD) is a multifactorial condition and the most common liver disease worldwide, affecting more than one-third of the population. So far there have been no reports on mendelian inheritance in families with NAFLD. METHODS:We performed whole-exome or targeted next-ge...

    journal_title:Journal of hepatology

    pub_type: 杂志文章


    authors: Youssefian L,Vahidnezhad H,Saeidian AH,Pajouhanfar S,Sotoudeh S,Mansouri P,Amirkashani D,Zeinali S,Levine MA,Peris K,Colombo R,Uitto J

    更新日期:2019-08-01 00:00:00