RT Journal
A1 Mailey B, Artinyan A, Khalili J, et al
T1 EValuation of absolute serum α-fetoprotein levels in liver transplant for hepatocellular cancer
JF Archives of Surgery
JO Archives of Surgery
YR 2011
FD January 1
VO 146
IS 1
SP 26
OP 33
DO 10.1001/archsurg.2010.295
UL http://dx.doi.org/10.1001/archsurg.2010.295
AB Hypothesis 
    An elevated serum α-fetoprotein (AFP) level before orthotopic liver transplant (OLT) is predictive of mortality after OLT for hepatocellular carcinoma (HCC).Design 
    Retrospective analysis of a population-based cohort.Setting 
    United Network for Organ Sharing registry (2003-2008).Patients 
    We identified 2253 patients who underwent OLT for HCC with available pre-OLT serum AFP values.Methods 
    Patients were stratified by AFP levels into low (<20 ng/mL), medium (20-399 ng/mL), or high (≥400 ng/mL) groups. Clinical and pathological characteristics were compared among groups. Survival curves were constructed by the Kaplan-Meier method, and univariate and multivariate Cox-regression analysis was performed.Results 
    Of the 2253 patients, 1210 (53.7%), 805 (35.7%), and 238 (10.6%) were in the low, medium, and high AFP groups, respectively. On univariate analysis, the low AFP group demonstrated the best 4-year survival (76%) compared with the medium (65%; P = .001) and high (57%; P < .001) AFP groups. When AFP levels in patients with only stage II HCC underwent assessment, improved survival in the low AFP group was still observed (P < .001). On multivariate analysis, the medium and high AFP groups were associated with higher mortality (hazard ratios, 1.50 [95% confidence interval, 1.19-1.89; P = .001] and 2.11 [1.55-2.88; P < .001], respectively).Conclusions 
    Serum AFP level is an independent prognostic predictor of outcome after OLT for HCC. The association between serum AFP value and post-OLT survival warrants further investigation to potentially better allocate donor allografts for HCC.