title: Elevation of CA-125 level is due to abdominal distension in liver transplantation candidates.
abstract: BACKGROUND
  CA (cancer antigen) 125 is a serologic marker used in the monitoring of ovarian cancer. Elevated levels are also reported in cirrhosis. We evaluated the range of serum CA 125 levels seen before and after liver transplantation, and examined possible factors associated with CA 125 elevation.
  
  
  METHODS
  We examined prospectively 57 consecutive patients with cirrhosis who underwent liver transplantation. CA 125 levels were also measured in two patients with polycystic liver disease.
  
  
  RESULTS
  The mean serum CA 125 level before transplantation was 352+/-549 u/ml, compared with 46+/-49 u/ml after transplantation (P<0.001). Multivariate analysis identified the degree of ascites as the only significant predictive variable of preoperative CA 125 level. In five patients who underwent abdominal paracentesis, the mean ascites CA 125 level (951+/-322 u/ml) was higher than that of the serum (619+/-290 u/ml) (P<0.003). In 16 hepatectomy specimens, the grade of staining for CA 125 was 0.8+/-1.4 for the mesothelium of patients with a normal serum CA 125 level, compared with 1.5+/-1.1 in patients with elevated serum levels (P=0.37). Two patients with severe abdominal distension due to polycystic liver disease but without ascites had elevated serum CA 125 levels.
  
  
  CONCLUSIONS
  CA 125 concentration is elevated in the majority of patients with cirrhosis and normalizes after liver transplantation. It is a reflection of the abdominal distention seen in these patients. Therefore, an elevation in CA 125 should not be considered a contraindication to liver transplantation in the absence of evidence of malignancy.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Royal Victoria Hospital, Montréal, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Deschênes
authors.forename: R P
authors.initials: RP
authors.lastname: Michel
authors.forename: E
authors.initials: E
authors.lastname: Alpert
authors.forename: J S
authors.initials: JS
authors.lastname: Barkun
authors.forename: P
authors.initials: P
authors.lastname: Metrakos
authors.forename: J
authors.initials: J
authors.lastname: Tchervenkov
mesh_terms: D001201:Ascites / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D018394:CA-125 Antigen / Q000097:blood*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000601:surgery*; D008113:Liver Neoplasms / Q000097:blood / Q000175:diagnosis; D016031:Liver Transplantation / Q000502:physiology*; D008297:Male; D011446:Prospective Studies; D012016:Reference Values; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D018394:CA-125 Antigen