Hepatocellular Carcinoma with Increased AFP Levels and Extrahepatic Manifestation after Liver Transplantation: A Case of Late-Onset Recurrence

Abstract

Liver transplantation is the best treatment modality in patients with hepatocellular carcinoma. The major concern after liver transplantation for hepatocellular carcinoma treatment is recurrence, because it’s the most important factor for the long term survival. There are two forms of recurrence; early-onset (within 2 years of liver transplantation) and late-onset (after 2 years of liver transplantation). A lot of factors have been reported in the literature to foresee recurrence after liver transplantation and one of them is alpha-fetoprotein. Many studies have shown that high levels of pre-transplant alpha-fetoprotein is related to early-onset recurrence and worse outcomes in the long term. In this case report, we report a case of late-onset recurrence, despite having high levels of pre-transplant alpha-fetoprotein in contrary to the literature, and still survive with a high quality of life 6 years after transplantation.