Alpha-Fetoprotein as a Modifier of Anatomic Criteria for Transplantation of HCC Patients

A. Daoud,^1,3 M. Ghobrial,¹ L. Teeter,² E. Graviss,² E. Asham,¹ S. Burroughs,¹ A. Saharia,¹ C. Mobley,¹ S. Mogawer,³ A. Sholkamy,³ M. Elshazly,⁴ M. Boktour,¹ A. Gaber.¹

¹Transplant Center, Methodist Hospital, Houston, TX
²Pathology and Genomic Medicine, Methodist Hospital, Houston, TX
³Internal Medicine Department, Cairo University Medical school, Cairo, Egypt
⁴Surgery Department, Cairo University Medical school, Cairo, Egypt.

Meeting: 2015 American Transplant Congress

Abstract number: D170

Keywords: Hepatocellular carcinoma, Liver transplantation

Session Information

Session Name: Poster Session D: Liver Transplantation for Hepatocellular Carcinoma

Session Type: Poster Session

Date: Tuesday, May 5, 2015

Session Time: 5:30pm-6:30pm

Presentation Time: 5:30pm-6:30pm

Location: Exhibit Hall E

Background:

The current listing criteria (Milan, UCSF) for Orthotropic Liver Transplants (OLT) in hepatocellular carcinoma (HCC) patients emphasize the anatomic features of the tumor such as size, burden and multiplicity. The Milan classification is widely used despite variations in dropout rates and survival between Milan patients. Additionally, recent reports have showed that patients with large tumors may have equivalent survival to Milan criteria patients. This suggests that differences in biologic behavior of tumors may contribute to outcome.

Aim:

To understand the impact of biologic modifiers such as Alpha-fetoprotein (AFP) on survival in both Milan & UCSF HCC patients.

Methods:

We reviewed all liver transplants reported to UNOS between 2002 & 2013. We analyzed the survival of patients transplanted for HCC who fit the Milan criteria & those transplanted with tumors beyond Milan and within UCSF criteria. We tested the impact of preoperative AFP levels on outcomes and tested various AFP level cut-offs in both groups in relationship to the 1,3& 5 year survival rates below & above the proposed cut-offs.

Results:

The 5 year survival for patients transplanted within Milan criteria remained acceptable (59.1%, 57.7% 65%, 60%) at AFP levels (≤1000; 1001-1500; 1501-2000; 2001-2500). Survival difference was significant between patients with AFP ≤ 2500 ng/ml & those with AFP > 2500 ng/ml (59.1% vs.37.4%; p<0.001). For patients transplanted with HCC beyond Milan but within UCSF criteria, The 5 year survival by AFP level was 56.7%, 47.1%, and 50% for AFP levels of 1-50, 51-100 and 101-150 respectively. Five yr. survival decreased to 20% for AFP level 151-200. Overall, the mean five year survival was 55% for patients with AFP≤ 150ng/ml and 35.7% for AFP >150 ng/ml (p=0.003).

Conclusion:

AFP level should be incorporated in the selection criteria for HCC patients considered for OLT. Patients within the Milan criteria with AFP level exceeding 2500 ng/ml have reduced survival. Patients with tumors beyond Milan and within UCSF criteria whose AFP≤ 150 ng/ml achieve acceptable five year survival and are good candidates for OLT.

To cite this abstract in AMA style:

Daoud A, Ghobrial M, Teeter L, Graviss E, Asham E, Burroughs S, Saharia A, Mobley C, Mogawer S, Sholkamy A, Elshazly M, Boktour M, Gaber A. Alpha-Fetoprotein as a Modifier of Anatomic Criteria for Transplantation of HCC Patients [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/alpha-fetoprotein-as-a-modifier-of-anatomic-criteria-for-transplantation-of-hcc-patients/. Accessed May 9, 2025.

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