Neil Mehta1, Jennifer L Dodge2, John P Roberts2, Ryutaro Hirose2, Francis Y Yao1,2. 1. Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, CA. 2. Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA.
Abstract
High alpha-fetoprotein (AFP) > 1,000 ng/mL is associated with poor outcomes after liver transplantation (LT) for hepatocellular carcinoma (HCC). A new national policy has been implemented for AFP > 1,000 ng/mL requiring a decrease to < 500 ng/mL before LT, but there is a paucity of data on the optimal AFP threshold before LT. We aimed to evaluate the effects of a reduction in AFP from > 1,000 ng/mL to different AFP thresholds before LT on survival and HCC recurrence after LT using the United Network for Organ Sharing database. We identified 407 patients who underwent transplant between January 2005 and September 2015 and who had AFP > 1,000 ng/mL at least once before LT. The last AFP measurement before LT was > 1,000 ng/mL in 72.0%, decreased from > 1,000 to 101-499 ng/mL in 9.6%, and decreased to ≤ 100 ng/mL in 14.3%. Local-regional therapy was not performed in 45.4% of patients with AFP > 1,000 ng/mL at LT versus 12.8% of those with AFP of 101-499 ng/mL and 10.3% of those with AFP ≤ 100 ng/mL at LT (P < 0.001). Kaplan-Meier 5-year post-LT survival for those with AFP > 1,000 ng/mL at LT was 48.8% versus 67.0% for those with a decrease in AFP to 101-499 ng/mL (P < 0.001) and 88.4% for those with AFP ≤ 100 ng/mL at LT (P < 0.001). HCC recurrence probability at 5 years was 35.0% for patients with AFP > 1,000 ng/mL versus 13.3% for patients with AFP of 101-499 ng/mL and 7.2% for patients with AFP ≤ 100 ng/mL at LT (P < 0.001). In multivariable analysis, a decrease in the AFP to 101-499 ng/mL was associated with a > 2-fold reduction in posttransplant mortality (P = 0.01) and a nearly 3-fold reduction in HCC recurrence (P = 0.02) compared with AFP > 1,000 ng/mL at LT. Conclusion: Our results demonstrated significantly improved post-LT outcomes when restricting LT to patients with a reduction in AFP from > 1,000 to < 500 ng/mL, validating the recently implemented national policy.
High alpha-fetoprotein (AFP) > 1,000 ng/mL is associated with poor outcomes after liver transplantation (LT) for hepatocellular carcinoma (HCC). A new national policy has been implemented for AFP > 1,000 ng/mL requiring a decrease to < 500 ng/mL before LT, but there is a paucity of data on the optimal AFP threshold before LT. We aimed to evaluate the effects of a reduction in AFP from > 1,000 ng/mL to different AFP thresholds before LT on survival and HCC recurrence after LT using the United Network for Organ Sharing database. We identified 407 patients who underwent transplant between January 2005 and September 2015 and who had AFP > 1,000 ng/mL at least once before LT. The last AFP measurement before LT was > 1,000 ng/mL in 72.0%, decreased from > 1,000 to 101-499 ng/mL in 9.6%, and decreased to ≤ 100 ng/mL in 14.3%. Local-regional therapy was not performed in 45.4% of patients with AFP > 1,000 ng/mL at LT versus 12.8% of those with AFP of 101-499 ng/mL and 10.3% of those with AFP ≤ 100 ng/mL at LT (P < 0.001). Kaplan-Meier 5-year post-LT survival for those with AFP > 1,000 ng/mL at LT was 48.8% versus 67.0% for those with a decrease in AFP to 101-499 ng/mL (P < 0.001) and 88.4% for those with AFP ≤ 100 ng/mL at LT (P < 0.001). HCC recurrence probability at 5 years was 35.0% for patients with AFP > 1,000 ng/mL versus 13.3% for patients with AFP of 101-499 ng/mL and 7.2% for patients with AFP ≤ 100 ng/mL at LT (P < 0.001). In multivariable analysis, a decrease in the AFP to 101-499 ng/mL was associated with a > 2-fold reduction in posttransplant mortality (P = 0.01) and a nearly 3-fold reduction in HCC recurrence (P = 0.02) compared with AFP > 1,000 ng/mL at LT. Conclusion: Our results demonstrated significantly improved post-LT outcomes when restricting LT to patients with a reduction in AFP from > 1,000 to < 500 ng/mL, validating the recently implemented national policy.
Authors: Gonzalo Sapisochin; Nicolas Goldaracena; Jerome M Laurence; Martin Dib; Andrew Barbas; Anand Ghanekar; Sean P Cleary; Les Lilly; Mark S Cattral; Max Marquez; Markus Selzner; Eberhard Renner; Nazia Selzner; Ian D McGilvray; Paul D Greig; David R Grant Journal: Hepatology Date: 2016-06-30 Impact factor: 17.425
Authors: Quirino Lai; Alessandro Vitale; Samuele Iesari; Armin Finkenstedt; Gianluca Mennini; Gabriele Spoletini; Maria Hoppe-Lotichius; Giovanni Vennarecci; Tommaso M Manzia; Daniele Nicolini; Alfonso W Avolio; Anna Chiara Frigo; Ivo Graziadei; Massimo Rossi; Emmanouil Tsochatzis; Gerd Otto; Giuseppe M Ettorre; Giuseppe Tisone; Marco Vivarelli; Salvatore Agnes; Umberto Cillo; Jan Lerut Journal: Hepatology Date: 2017-11-06 Impact factor: 17.425
Authors: Quirino Lai; Alfonso W Avolio; Ivo Graziadei; Gerd Otto; Massimo Rossi; Giuseppe Tisone; Pierre Goffette; Wolfgang Vogel; Michael B Pitton; Jan Lerut Journal: Liver Transpl Date: 2013-10 Impact factor: 5.799
Authors: Maria Reig; Alejandro Forner; Jordi Rimola; Joana Ferrer-Fàbrega; Marta Burrel; Ángeles Garcia-Criado; Robin K Kelley; Peter R Galle; Vincenzo Mazzaferro; Riad Salem; Bruno Sangro; Amit G Singal; Arndt Vogel; Josep Fuster; Carmen Ayuso; Jordi Bruix Journal: J Hepatol Date: 2021-11-19 Impact factor: 30.083
Authors: Cem Simsek; Amy Kim; Michelle Ma; Nilay Danis; Merve Gurakar; Andrew M Cameron; Benjamin Philosophe; Jacqueline Garonzik-Wang; Shane Ottmann; Ahmet Gurakar; Behnam Saberi Journal: Hepatoma Res Date: 2020-03-20
Authors: Karolina Grąt; Ryszard Pacho; Michał Grąt; Marek Krawczyk; Krzysztof Zieniewicz; Olgierd Rowiński Journal: J Clin Med Date: 2019-10-13 Impact factor: 4.241