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Fatourou et al. Hepatoma Res 2018;4:63 Hepatoma Research
DOI: 10.20517/2394-5079.2018.62

Review Open Access

Alpha-fetoprotein as a predictor of hepatocellular
carcinoma recurrence following liver transplantation

Evangelia M. Fatourou, Abid R. Suddle, Michael A. Heneghan
Institute of Liver Studies, King’s College Hospital, Denmark Hill, London SE5 9RS, UK.

Correspondence to: Prof. Michael A Heneghan, Institute of Liver Studies, King’s College Hospital, Denmark Hill, London SE5 9RS, UK.
E-mail: michael.heneghan@nhs.net

How to cite this article: Fatourou EM, Suddle AR, Heneghan MA. Alpha-fetoprotein as a predictor of hepatocellular carcinoma
recurrence following liver transplantation. Hepatoma Res 2018;4:63. http://dx.doi.org/10.20517/2394-5079.2018.62

Received: 17 May 2018 First Decision: 3 Jul 2018 Revised: 18 Jul 2018 Accepted: 30 Jul 2018 Published: 10 Oct 2018
Science Editor: Guang-Wen Cao Copy Editor: Jun-Yao Li Production Editor: Zhong-Yu Guo

Abstract
Alpha-fetoprotein (AFP) has been increasingly recognised as a valuable marker in predicting HCC recurrence post-
liver transplantation. Moreover, its secretion has been associated with poor histological tumour characteristics as
it reflects an aggressive tumour biological behaviour. This review aims to summarise the emerging evidence on the
use of AFP either as an independent marker, or as a variable incorporated into prognostic models. For this purpose,
an electronic PubMed literature search was performed. Due to the heterogeneity of the reported studies, drawing
clear conclusions about the optimum AFP cut-off level to predict recurrence is difficult. Models that include AFP
at different cut-offs have been shown be superior to Milan criteria in predicting disease recurrence, but need to
be prospectively validated in order to confirm their prognostic value. Until more refined methods for selecting
patients become available, existing evidence support the use of AFP in decision models for liver transplantation.

Keywords: Alpha-fetoprotein, hepatocellular carcinoma, liver transplantation, recurrence, survival

INTRODUCTION
Hepatocellular carcinoma (HCC) is expected to become a leading cause for liver transplantation (LT) following
curative treatment for hepatitis C and after more widespread acceptance of the practice of tumour down-
[1]
staging for patients originally considered beyond LT criteria . It has been estimated that patients with HCC
currently represent 30%-35% of the waiting list population in Europe and in an era of organ shortage, selecting
[2]
the best candidates for LT with the lowest risk of post-transplant recurrence poses a clinical challenge .
It is evident that even after applying the most restrictive tumour burden selection criteria, 10%-15% of patients

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
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