The impact of waiting list alpha-fetoprotein changes on the outcome of liver transplant for hepatocellular carcinoma

Merani, Shaheed; Majno, Pietro; Kneteman, Norman M.; Berney, Thierry; Morel, Philippe; Mentha, Gilles; Toso, Christian

doi:10.1016/j.jhep.2010.12.040

Cited by 162 publications

(169 citation statements)

References 24 publications

Supporting

Mentioning

157

Contrasting

Unclassified

Order By: Relevance

“…For instance, the results of 2 recent studies identified that AFP levels greater than 400 μg/L were associated with decreased overall survival after LT. 26,27 Using the Scientific Registry of Transplant Recipients database, one study identified total tumor volume and AFP level > 400 μg/L as the only predictive factors of patient survival after transplant. 26 However, HCC recurrence could not be evaluated.…”

Section: Alpha-fetoprotein Levelmentioning

confidence: 99%

“…Likewise Merani and associates showed that patient survival was increased if the AFP level was reduced < 400 μg/L with locoregional control when compared with those patients whose AFP level did not decrease with treatment. 27 The rate of AFP increase also has been associated with recurrent HCC in liver transplant recipients. 28,29 Vibert and associates found that HCC recurrence occurred significantly more often in patients who had a rise in AFP > 15 μg/L/mo before transplant.…”

Section: Alpha-fetoprotein Levelmentioning

confidence: 99%

See 1 more Smart Citation

Management of Recurrent Hepatocellular Carcinoma in Liver Transplant Recipients: A Systematic Review

Rubin

Ayoub²,

Kaldas³

et al. 2012

Exp Clin Transplant

View full text Add to dashboard Cite

Hepatocellular carcinoma is the most common form of liver cancer, representing 70% to 85% of primary hepatic malignancies in adults. Liver transplant is an optimal treatment for patients with hepatocellular carcinoma because it eliminates the malignancy as well as the oftenunderlying liver cirrhosis and restores normal liver function. Since the development of strict selection criteria in hepatocellular carcinoma patients undergoing liver transplant with the implementation of the Milan criteria, patient survival and recurrence rates after liver transplant have dramatically improved. However, several research groups are now seeking to expand this criteria to include more patients with larger tumors who may achieve similar postliver transplant survival rates as those patients meeting current eligibility requirements. Currently, in approximately 20% of patients, hepatocellular carcinoma recurrence is still the rate-limiting event that clearly affects patient survival.Given the limited number of grafts available for transplant, the poor prognosis of untreated hepatocellular carcinoma, and the recent notion of expanding selection criteria, strategies for reducing the rate of, monitoring and treating hepatocellular carcinoma recurrence, in both pretransplants and posttransplants, are explored in this review. We review the available literature to better understand current strategies available to optimize long-term clinical outcomes.

show abstract

Section: Alpha-fetoprotein Levelmentioning

confidence: 99%

Section: Alpha-fetoprotein Levelmentioning

confidence: 99%

Management of Recurrent Hepatocellular Carcinoma in Liver Transplant Recipients: A Systematic Review

Rubin

Ayoub²,

Kaldas³

et al. 2012

Exp Clin Transplant

View full text Add to dashboard Cite

show abstract

“…33 We investigated the relevance and relative impact of absolute values of AFP levels and changes in patients on the waiting list with respect to dropout and survival rates, and we studied whether AFP down-staging could be a meaningful pretransplant criterion.…”

Section: Candidate Biomarkersmentioning

confidence: 99%

Tools for monitoring patients with hepatocellular carcinoma on the waiting list and after liver transplantation

Kneteman¹,

Livraghi²,

Madoff³

et al. 2011

Liver Transpl

View full text Add to dashboard Cite

For patients who are initially being listed for liver transplantation and for patients who are seeking to retain their active status on the wait list, the first step in the diagnostic consideration of hepatocellular carcinoma (HCC) is the accurate identification and staging of the tumors. Advances in imaging and biomarkers have improved our ability to diagnose HCC and in parallel have reduced the incidence of incidental HCC after liver transplantation. For the initial diagnosis, high sensitivity and high specificity are paramount considerations. The requirements change, however, when we are considering listing for transplantation: then, the prediction of the risk for posttransplant tumor recurrence and patient survival assume primacy. We must understand with confidence not only that the patient has a tumor but also that the tumor will affect the 5-year patient survival rate through the risk of tumor recurrence.Our first task in making the decision to list a patient with HCC for liver transplantation is to rule out factors representing absolute contraindications: extrahepatic disease and macrovascular tumor invasion. Beyond these variables, an understanding of the risk of posttransplant HCC recurrence is dominated by 2 major variables: tumor mass and tumor biology. Three major types of information can inform the decision to list a patient with HCC for liver transplantation. The first and usually dominant factors are the imaging characteristics, which include the size and number of the malignant lesions. The second type consists of biomarkers, which are most commonly abnormal proteins in the circulation that signify the presence of more dedifferentiated malignant cells with a higher propensity to invade and metastasize. The third type consists of factors from histological evaluations of tumor tissue obtained by biopsy or excision; these include factors such as the tumor grade, the presence of microvascular invasion, and protein, messenger RNA (mRNA), or DNA markers that have been correlated with more aggressive tumor behavior.Our team was tasked with generating recommendations for the best protocol for monitoring HCC patients on the wait list and for screening them for tumor recurrence after transplantation. The role of

show abstract

“…2, 3 However, in our opinion, one of the most important results of this study is the fact that when the patients who underwent locoregional treatment before liver transplantation and whose alpha-fetoprotein levels were assessed multiple times were evaluated, the group whose serum alphafetoprotein levels decreased, even minimally and without normalization, had no excess posttransplant mortality, whereas the posttransplant mortality rate remained elevated for the patients with no alphafetoprotein response. Probably more importantly, the excess mortality was attributed to malignancies, although the explored database did not allow more indepth discrimination between recurrent and de novo hepatocellular carcinoma.…”

Section: To the Editorsmentioning

confidence: 85%

Predicting the posttransplant prognosis of patients with hepatocellular carcinoma: What lies beneath alpha-fetoprotein?

Giannini

Savarino

2013

Liver Transpl

View full text Add to dashboard Cite

The impact of waiting list alpha-fetoprotein changes on the outcome of liver transplant for hepatocellular carcinoma

Cited by 162 publications

References 24 publications

Management of Recurrent Hepatocellular Carcinoma in Liver Transplant Recipients: A Systematic Review

Management of Recurrent Hepatocellular Carcinoma in Liver Transplant Recipients: A Systematic Review

Tools for monitoring patients with hepatocellular carcinoma on the waiting list and after liver transplantation

Predicting the posttransplant prognosis of patients with hepatocellular carcinoma: What lies beneath alpha-fetoprotein?

Contact Info

Product

Resources

About