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Invited Critique
January 2011January 17, 2011

AFP in OLT for HCC?: Another Shadow on the Cave Wall: Comment on “Evaluation of Absolute Serum α-Fetoprotein Levels in Liver Transplant for Hepatocellular Cancer”

Author Affiliations

Author Affiliation: Comprehensive Transplant Center, Department of Surgery, The Johns Hopkins University, Baltimore, Maryland.

Arch Surg. 2011;146(1):33-34. doi:10.1001/archsurg.2010.280

The first liver transplant was performed by Starzl 40 years ago for a patient with liver cancer.1 Since that historic event, transplant has had an evolving role as treatment for HCC. An initial period of aggressiveness led to unacceptably poor recurrence rates and patient outcomes that compared unfavorably with nonmalignant indications for OLT. In 1996, Mazzaferro et al2 reported excellent results with early-stage liver cancers, prompting rapid adoption of the Milan criteria: “1 tumor less than 5 cm or 3 less than 3.” When UNOS moved to the MELD system in 2002, they made provision for exception points for Milan-sized HCCs, resulting in a 6-fold increase in transplants for HCC.