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>400ng/ml at the time of listing who were downstaged to AFP⩽400ng/ml had better intent-to-treat survival than patients failing to reduce AFP to⩽400 (81% vs. 48% at 3years, p⩽0.001) and comparable survival to patients with stable AFP⩽400ng/ml (74%, p=0.14). Patients with AFP levels decreased⩽400ng/ml and patients with levels persistently⩽400ng/ml also had similar drop-out rates from the list (10% in both groups) and post-transplant survival rates (89% vs. 78% at 3years, p=0.11). Such an AFP downstaging was associated with good survivals whatever the level of the original AFP (even if originally>1000ng/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.[1]References
- The impact of waiting list alpha-fetoprotein changes on the outcome of liver transplant for hepatocellular carcinoma. Merani, S., Majno, P., Kneteman, N.M., Berney, T., Morel, P., Mentha, G., Toso, C. J. Hepatol. (2011) [Pubmed]
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