Author/Authors :
kim, seok-hwan university of ulsan - asan medical center, college of medicine - division of hepatobiliary surgery and liver transplantation, department of surgery, Seoul, south korea , moon, deok-bog university of ulsan - asan medical center, college of medicine - division of hepatobiliary surgery and liver transplantation, department of surgery, Seoul, South Korea , kim, wan-joon university of ulsan - asan medical center, college of medicine - division of hepatobiliary surgery and liver transplantation, department of surgery, Seoul, South Korea , kang, woo-hyoung university of ulsan - asan medical center, college of medicine - division of hepatobiliary surgery and liver transplantation, department of surgery, Seoul, South Korea , kwon, jae hyun university of ulsan - asan medical center, college of medicine - division of hepatobiliary surgery and liver transplantation, department of surgery, Seoul, South Korea , jwa, eun kyung university of ulsan - asan medical center, college of medicine - division of hepatobiliary surgery and liver transplantation, department of surgery, Seoul, South Korea , cho, hwui-dong university of ulsan - asan medical center, college of medicine - division of hepatobiliary surgery and liver transplantation, department of surgery, Seoul, South Korea , ha, su-min university of ulsan - asan medical center, college of medicine - division of hepatobiliary surgery and liver transplantation, department of surgery, Seoul, South Korea , chung, yong-kyu university of ulsan - asan medical center, college of medicine - division of hepatobiliary surgery and liver transplantation, department of surgery, Seoul, South Korea , lee, sung-gyu university of ulsan - asan medical center, college of medicine - division of hepatobiliary surgery and liver transplantation, department of surgery, Seoul, South Korea
Abstract :
Background: Adult living donor liver transplantation (LDLT) is one of the best treatments for hepatocellular carcinoma (HCC). However, when recurrence of HCC after LDLT occurs, the prognosis is poor because of rapid progression. Preoperative level of α-fetoprotein (AFP) and protein induced by vitamin K antagonist-II (PIVKA-II) reportedly correlate with recurrence of HCC after LDLT. Methods: We examined AFP and PIVKA-II preoperatively as predictors of HCC recurrence in 461 patients who underwent LDLT using right liver graft for HCC from May 2007 to December 2013. Results: Among these, 77 patients (16.7%) who experienced recurrence were retrospectively reviewed. Multivariate analysis revealed tumor size 5 cm, AFP 150 nag/mol and PIVKA-II 100 maul/mol as significant independent risk factors for recurrence. The median time to recurrence was 10 months. The median survival time after recurrence was 26 months, and the 1-, 3- and 5-year survival rates after recurrence were 80.5%, 58%, and 28.3% respectively. Conclusions: Preoperatively, not only morphology of the tumor but also AFP and PIVKA-II levels can offers important information for the recurrence after LDLT for HCC. Thus, combination of tumor markers might be used for expansion of pre-existing strict selection criteria of liver transplantation for HCC.
Keywords :
α , fetoprotein (AFP) , protein induced by vitamin K absence or antagonist , II (PIVKA , II) , living donor liver transplantation (LDLT) , prognostic factor , recurrence
