Pre-transplant alpha-fetoprotein is associated with post-transplant hepatocellular carcinoma recurrence mortality

Nadim Mahmud, Binu John, Tamar H. Taddei, David S. Goldberg

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Background: Although liver transplantation may potentially cure hepatocellular carcinoma (HCC), the risk of HCC recurrence is 8%-20% at five years post-transplant. Pre-transplant alpha-fetoprotein (AFP) is a predictor of HCC recurrence, but it is unknown if pre-transplant AFP also predicts survival in patients with recurrence. Methods: We performed a retrospective cohort study using the United Network for Organ Sharing (UNOS) database between 2002 and 2016. We identified adult transplant recipients with HCC recurrence after liver transplantation for HCC and used Cox regression to compare patient survival among different maximum pre-transplant AFP levels. Results: The cohort (N = 1164) was primarily male, white, and with hepatitis C liver disease. The median time to HCC recurrence was 11.6 months (interquartile range 6.1-26.3). In Cox regression analysis, increasing pre-transplant AFP was associated with poorer survival when adjusting for age, pre-transplant model for end-stage liver disease (MELD), and time to HCC recurrence. For example, patients with pre-transplant AFP ≥500ng/mL had a 1.6-fold higher risk of death versus those with AFP ≤20ng/mL (P < 0.001). Conclusion: Pre-transplant AFP is independently associated with survival in patients with HCC recurrence. These findings further contextualize the importance of pre-transplant AFP in liver transplantation and may improve prognostication for patients with HCC recurrence.

Original languageEnglish (US)
Article numbere13634
JournalClinical Transplantation
Issue number7
StatePublished - Jul 2019
Externally publishedYes


  • liver transplantation
  • national registry data
  • risk stratification
  • survival analysis
  • United Network for Organ Sharing

ASJC Scopus subject areas

  • Transplantation


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