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Galdino-Vasconcelos MR, Feijó MS, Ferro HM, Gomes ACR, De Almeida Santos ME, Ferreira G, Jorge F, Trevizoli N, Diaz LG, De Campos PB, Cajá G, Ullmann R, Figueira AV, Morato T, Watanabe ALC. Preoperative Alpha-Fetoprotein and Radiological Total Tumor Diameter as Predictors of Hepatocellular Carcinoma Recurrence After Liver Transplantation. Transplant Proc 2022; 54:1333-1340. [PMID: 35768294 DOI: 10.1016/j.transproceed.2022.02.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 02/09/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Liver transplantation is a unique treatment opportunity for patients with chronic liver disease and hepatocellular carcinoma (HCC). Selection of HCC patients for transplantation was revolutionized by Milan-based criteria, but tumor recurrence and shortage of organs are still a major concern. Nowadays, additional preoperative tumor parameters can help to refine the graft allocation process. The objective of this study was to evaluate the prognostic value and cut-off points of pretransplant serum alpha-fetoprotein (AFP) levels and radiological tumor parameters on liver transplantation outcomes. METHODS This is a single-team retrospective cohort of 162 consecutive deceased donor liver transplants (DDLT) with pathologically confirmed HCC. Pretransplant serum AFP levels and radiological tumor parameters were retrieved from a preoperative follow-up. Receiver-operating characteristics (ROC) curves were used to evaluate cut-off points for each outcome. Multivariate Cox regression model was used to assess the predictors of HCC relapse and recipient mortality. RESULTS Twelve recipients (7.4%) had HCC recurrence after transplantation, with median survival time of 5.8 months. Pretransplant AFP ≥30 ng/mL (hazard ratio [HR]: 13.84, P = .003) and radiological total tumor diameter (TTD) ≥5 cm (HR: 12.89, P = .005) were independent predictors for HCC relapse. Moreover, pretransplant AFP ≥150 ng/mL was independently associated with recipient mortality (HR: 4.45, P = .003). CONCLUSIONS Pretransplant AFP levels and radiological TTD were independently associated with HCC relapse and recipient mortality after DDLT, with different cut-off points predicting different outcomes. These findings may contribute to improving decision-making in the context of liver transplantation for HCC patients.
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Affiliation(s)
| | - Mateus Silva Feijó
- Faculty of Medicine, University of Brasilia, Campus Universitário Darcy Ribeiro, Brasilia, Federal District, Brazil.
| | - Henrique Metzker Ferro
- Faculty of Medicine, University of Brasilia, Campus Universitário Darcy Ribeiro, Brasilia, Federal District, Brazil
| | - Ana Clara Ramalho Gomes
- Faculty of Medicine, University of Brasilia, Campus Universitário Darcy Ribeiro, Brasilia, Federal District, Brazil
| | | | - Gustavo Ferreira
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Brasilia, Federal District, Brazil
| | - Fernando Jorge
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Brasilia, Federal District, Brazil; Department of Liver Transplantation, Hospital Brasilia, Brasilia, Federal District, Brazil
| | - Natália Trevizoli
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Brasilia, Federal District, Brazil; Department of Liver Transplantation, Hospital Brasilia, Brasilia, Federal District, Brazil
| | - Luiz Gustavo Diaz
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Brasilia, Federal District, Brazil; Department of Liver Transplantation, Hospital Brasilia, Brasilia, Federal District, Brazil
| | - Priscila Brizolla De Campos
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Brasilia, Federal District, Brazil; Department of Liver Transplantation, Hospital Brasilia, Brasilia, Federal District, Brazil
| | - Gabriel Cajá
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Brasilia, Federal District, Brazil; Department of Liver Transplantation, Hospital Brasilia, Brasilia, Federal District, Brazil
| | - Raquel Ullmann
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Brasilia, Federal District, Brazil; Department of Liver Transplantation, Hospital Brasilia, Brasilia, Federal District, Brazil
| | - Ana Virgínia Figueira
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Brasilia, Federal District, Brazil; Department of Liver Transplantation, Hospital Brasilia, Brasilia, Federal District, Brazil
| | - Tiago Morato
- Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Brasilia, Federal District, Brazil; Department of Liver Transplantation, Hospital Brasilia, Brasilia, Federal District, Brazil
| | - André Luís Conde Watanabe
- Faculty of Medicine, University of Brasilia, Campus Universitário Darcy Ribeiro, Brasilia, Federal District, Brazil; Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal (ICDF), Brasilia, Federal District, Brazil; Department of Liver Transplantation, Hospital Brasilia, Brasilia, Federal District, Brazil
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