Peri-transplant change in AFP level: A useful predictor of hepatocellular carcinoma recurrence following liver transplantation

Tae Yoo, Kwang Woong Lee, Nam Joon Yi, Young Rok Choi, Hyeyoung Kim, Suk Won Suh, Jae Hong Jeong, Jeong Moo Lee, Kyung Suk Suh

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Pretransplant alpha-fetoprotein (AFP) is a useful tumor marker predicting recurrence of hepatocellular carcinoma (HCC). Little is known, however, about the relationship between changes in AFP concentration and prognosis. This study investigated the clinical significance of change in peri-transplant AFP level as a predictor of HCC recurrence. Data from 125 HCC patients with elevated pretransplant AFP level who underwent liver transplantation (LT) between February 2000 and December 2010 were retrospectively reviewed. Patients with AFP normalization within 1 month after LT were classified into the rapid normalization group (n = 97), with all other patients classified into the non-rapid normalization group (n = 28). Tumor recurrence was observed in 17 of the 97 patients (17.5%) with rapid normalization; of these, 11 patients had high AFP levels and six had normal levels at recurrence. In contrast, tumor recurrence was observed in 24 of the 28 patients (85.7%) without rapid normalization, with all 24 having high AFP levels at recurrence. Multivariate analysis showed that non-rapid normalization (harzard ratio [HR], 4.41, P < 0.001), sex (HR, 3.26, P = 0.03), tumor size (HR, 1.15, P = 0.001), and microvascular invasion (HR, 2.65, P = 0.005) were independent risk factors for recurrence. In conclusion, rapid normalization of post-LT AFP level at 1 month is a useful clinical marker for HCC recurrence. Therefore, an adjuvant strategy and/or intensive screening are needed for patients who do not show rapid normalization.

Original languageEnglish
Pages (from-to)1049-1054
Number of pages6
JournalJournal of Korean Medical Science
Issue number7
StatePublished - 2016


  • Alpha-fetoprotein
  • Hepatocellular carcinoma
  • Liver cancer
  • Liver transplantation
  • Tumor marker

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