Current criteria used to select hepatocellular carcinoma (HCC) patients for liver transplant focus on the anatomic features of the tumor. Research from Dr. A. Osama Gaber, Chair of the Department of Surgery and John F., Jr. and Carolyn Bookout Presidential Distinguished Chair in Surgery, and colleagues shows that adding biologic modifiers such as alpha-fetoprotein (AFP) will help us better select HCC patients for liver transplant and better predict long-term survival of the patient. Liver transplantation is one of the best treatments available for patients with HCC when restricted to suitable candidates.

The study involved an analysis of 11,929 patients entered into the UNOS database between 2002 and 2013. Incorporating information from such a large number of patients, and using the UNOS Star files, adds significance to the study.

Results showed that patients within the Milan criteria who have an AFP level exceeding 2500 ng/mL have reduced survival. Thus, patients within the Milan criteria should be considered eligible for liver transplant if AFP level does not exceed 2500 ng/mL. Patients with tumors beyond Milan and within University of California San Francisco (UCSF) criteria, whose AFP is less than or equal to 150 ng/mL, achieve acceptable 5-year survival and are good candidates for liver transplant.

See the study in Transplantation Proceedings for full details and a discussion of the findings.