Format

Send to

Choose Destination
Clin Transplant. 2019 Jul;33(7):e13634. doi: 10.1111/ctr.13634. Epub 2019 Jun 25.

Pre-transplant alpha-fetoprotein is associated with post-transplant hepatocellular carcinoma recurrence mortality.

Author information

1
Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
2
Virginia Commonwealth University, Richmond, Virginia.
3
McGuire VA Medical Center, Richmond, Virginia.
4
Division of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut.
5
VA Connecticut Healthcare System, West Haven, Connecticut.
6
Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

Abstract

BACKGROUND:

Although liver transplantation may potentially cure hepatocellular carcinoma (HCC), the risk of HCC recurrence is 8%-20% at five years post-transplant. Pre-transplant alpha-fetoprotein (AFP) is a predictor of HCC recurrence, but it is unknown if pre-transplant AFP also predicts survival in patients with recurrence.

METHODS:

We performed a retrospective cohort study using the United Network for Organ Sharing (UNOS) database between 2002 and 2016. We identified adult transplant recipients with HCC recurrence after liver transplantation for HCC and used Cox regression to compare patient survival among different maximum pre-transplant AFP levels.

RESULTS:

The cohort (N = 1164) was primarily male, white, and with hepatitis C liver disease. The median time to HCC recurrence was 11.6 months (interquartile range 6.1-26.3). In Cox regression analysis, increasing pre-transplant AFP was associated with poorer survival when adjusting for age, pre-transplant model for end-stage liver disease (MELD), and time to HCC recurrence. For example, patients with pre-transplant AFP ≥500ng/mL had a 1.6-fold higher risk of death versus those with AFP ≤20ng/mL (P < 0.001).

CONCLUSION:

Pre-transplant AFP is independently associated with survival in patients with HCC recurrence. These findings further contextualize the importance of pre-transplant AFP in liver transplantation and may improve prognostication for patients with HCC recurrence.

KEYWORDS:

United Network for Organ Sharing; liver transplantation; national registry data; risk stratification; survival analysis

PMID:
31177570
PMCID:
PMC6635076
[Available on 2020-07-01]
DOI:
10.1111/ctr.13634

Supplemental Content

Full text links

Icon for Wiley
Loading ...
Support Center