Circulating biomarkers of mortality prediction in patients undergoing liver transplantation due to hepatocellular carcinoma

Abstract

There are different macromorphological factors obtained prior to liver transplantation (LT) to predict the prognosis of hepatocellular carcinoma (HCC) patients undergoing LT. The use of blood biomarkers could help improve the prognosis prediction of these patients. Blood levels of alpha-fetoprotein (AFP) are the first and most studied prognostic blood biomarkers of HCC patients undergoing LT. This review is to summarize the evidence of prognostic blood biomarkers for HCC patients undergoing LT. A higher mortality rate has been found with high blood levels of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), C-reactive protein (CRP), albumin-bilirubin (ALBI) score, des-gamma-carboxy prothrombin (DCP), lactate dehydrogenase (LDH), gamma glutamyl transpeptidase (GGT), fibrinogen, vascular endothelial growth factor (VEGF), homocysteine, Golgi protein 73 (GP73), substance P, soluble CD40 ligand (sCD40L), caspase-cleaved cytokeratin (CCCK)-18, caspase-3, malondialdehyde and oxidized guanine species (OGS). A higher mortality rate has been found with low blood levels of lymphocyte-to-monocyte ratio (LMR), PD-L1, Galectin-9, total antioxidant capacity (TAC) and melatonin. Moreover, some studies with small sample sizes associate blood levels of metabolites and microRNAs (MIRs) with the prognosis of HCC patients undergoing LT. More research is warranted to determine the possible utility of these biomarkers to predict the prognosis of HCC.