Abstract
BackgroundLiver transplantation (LT) is the best treatment for selected patients with cirrhosis and small hepatocellular carcinoma (HCC) who are not candidates for resection. The proinflammatory effects of systemic inflammatory response have been linked with HCC. Therefore, the measurement of inflammatory markers represents a significant tool to limit recurrence after LT.ResultsThere are eleven patients with HCC recurrence post-transplantation. Pre-transplantation AFP can predict HCC recurrence with the best cutoff value of > 17.8 ng/ml with a sensitivity of 82% and specificity of 70%. Post-transplantation CRP can predict HCC recurrence with the best cutoff value of > 0.85 (mg/dl) with a sensitivity of 73% and specificity of 71%. Other inflammatory markers NLR and PLR were not significant in predicting HCC recurrence. Moreover, HCC recurrence significantly affects the outcome of patients undergoing LT (p value < 0.001) with a worse prognosis.ConclusionOur results showed additional benefits of inflammatory markers as CRP to standard parameters in predicting HCC recurrence to refine recipient selection and achieve better survival outcomes post-LT.
Highlights
Liver transplantation (LT) is the best treatment for selected patients with cirrhosis and small hepatocellular carcinoma (HCC) who are not candidates for resection
HCC was diagnosed according to EASL guidelines (2018), and we have focused on 1-week pretransplantation to document the laboratory investigations including CBC with differential, C-reactive protein (CRP) and AFP, Pre-operative Child-Turcotte-Pugh Scoring System, and postoperative laboratory investigations (NLR, platelet to lymphocyte ratio (PLR), AFP, CRP) after 1 week, in addition to the histological examination of the explant pathology to assess the microvascular invasion and the grade of differentiation according to Edmondson and Steiner Grading System
It was found out that HCC recurrence significantly affects the outcome of patients undergoing LT (p < 0.001) (Tables 4 and 5)
Summary
Liver transplantation (LT) is the best treatment for selected patients with cirrhosis and small hepatocellular carcinoma (HCC) who are not candidates for resection. The proinflammatory effects of systemic inflammatory response have been linked with HCC. The Milan criteria are widely used for patient selection for liver transplantation in patients with HCC. The recurrence rate of HCC is approximately 15–20% [2], even among patients who fulfill the Milan criteria. Different factors are incriminated in the development of HCC; one of them is inflammation as it promotes. They facilitate angiogenesis and tumor progression through activation of different oncogenes as RAS and MYC resulting in cytokine-rich tumor microenvironment and granulocyte recruitment and activation [5]. Inflammatory indices as neutrophil to lymphocyte ratio (NLR), the platelet to lymphocyte ratio (PLR), and C-reactive protein (CRP) have been widely investigated as prognostic values for HCC [7]
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