AFP role in predicting recurrence of hepatocellular carcinoma after living donor liver transplantation in HCV patients

HCC is one of the leading causes of death worldwide. Liver transplantation including living donor transplantation is the best available treatment. We have analyzed our experience with LDLT (living donor liver transplantation) in patients with HCC and HCV in order to determine if alpha feto-protein (AFP) is a better predictor of recurrence than the tumor burden. We have identified all patients with HCV related liver disease and HCC who have undergone LDLT in one center during the period from December 2000 to December 2014. Outcomes from the prospective database were compared for patients who met Milan criteria (single tumor ≤5 cm, maximum of 3 total tumors with none >3 cm) or not. Uni-and multi-variable analyses of factors influencing recurrence free survival (RFS) were performed. A total of 142 patients with HCC and HCV associated liver disease underwent LDTL during the study period. RFS was 96.4% at 1 year, 91.8% at 3 years and 91.8% at 5 years. Gender, Model for End-stage Liver Disease (MELD), pre-transplant therapy, AFP level, tumor number, total tumor size were predictors of recurrence in univariable analysis. In multivariable analysis MELD score (Hazard ratio (HR) 1.16) and Log10 AFP (HR 3.14) were predictors of RFS. In the ROC curve analysis with an AUC of 0.76 the optimal cut-off value of AFP was 26 ng/mL. In conclusion, MELD score and pre-transplant AFP predict recurrence after LDLT for HCC with HCV infection.