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Invited Commentary
October 05, 2016

Promise and Pitfalls of Using α-Fetoprotein in Liver Transplantation Allocation for Hepatocellular Carcinoma

Author Affiliations
  • 1Division of Gastroenterology and Hepatology, Department of Medicine, Oregon Health & Science University, Portland
  • 2Division of Abdominal Organ Transplantation/Hepatobiliary Surgery, Department of Surgery, Oregon Health & Science University, Portland
  • 3Portland Veterans Administration Medical Center Transplant Program, Portland, Oregon
JAMA Surg. Published online October 5, 2016. doi:10.1001/jamasurg.2016.3495

Serum α-fetoprotein (AFP) testing is no longer recommended for hepatocellular carcinoma (HCC) screening or diagnosis.1 However, AFP remains a valuable tool to monitor treatment response in the 60% to 75% of patients with AFP-producing tumors,13 and as a prognostic marker for recurrence after a liver transplant (LT).46 Although low or decreasing AFP levels at the time of LT predict a lower risk of recurrence, studies have not distinguished HCCs with low AFP levels as a result of cancer treatment from HCCs that do not produce AFP. Thus, it is uncertain whether conventional predictors of recurrence of HCC after LT extend to the subgroup of non-AFP–producing tumors, or whether the lack of AFP production indicates a distinct cancer behavior and prognosis.

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