Serum Vascular Endothelial Growth Factor Level in Patients with Hepatocellular Carcinoma Undergoing Liver Transplantation: Experience of a Single Western Center

Background: The strongest predictor of tumor relapse after liver transplantation for hepatocellular carcinoma (HCC) is vascular invasion, appreciated only on explant analysis. High serum level of vascular endothelial growth factor (VEGF) is associated with worse outcomes after resection or locoregional therapies but its role in liver transplantation remains undefined. Objective: We report the first western prospective study exploring serum VEGF in HCC liver transplant patients, correlating pre-operative serum VEGF with poor prognostic histologic features during explant analysis. Methods: Between May 2008, and June 2010, 75 HCC patients underwent liver transplantation at our in- stitution. Serum VEGF was measured every 3 months until liver transplantation and correlated with his- topathologic findings on explant. Results: There was no significant correlation between pre-transplant serum VEGF levels and tumor bur- den (median 31.0 pg/mL vs. 42.5 pg/mL, p=0.33, for tumors within and beyond the Milan criteria, re- spectively). Pre-transplant VEGF levels were higher in poorly differentiated tumors compared to well to moderately differentiated tumors, but not statistically significant (median 49.0 pg/mL vs. 31.0 pg/mL, p=0.26). Pre-transplant VEGF did not correlate with vascular invasion (median 37.0 pg/mL vs. 31.0 pg/ mL, p=0.35, in the presence and absence of vascular invasion, respectively). Conclusion: Pre-operative serum VEGF fails to predict unfavorable histologic HCC features in patients un- dergoing liver transplantation. Role of serum VEGF in liver transplant HCC patients remains unclear.