Author(s): Merani S, Majno P, Kneteman NM, Berney T, Morel P,
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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. Copyright © 2011 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
This article was published in J Hepatol
and referenced in Journal of Clinical & Cellular Immunology