Postoperative surveillance with monthly serum tumor markers after living-donor liver transplantation for hepatocellular carcinoma.
OBJECTIVE
Recurrence of hepatocellular carcinoma (HCC) after liver transplantation decreases patient survival. The usefulness of post-transplant surveillance with tumor markers, however, is not clear. We evaluated our cumulative experience with recurrent HCC detected during post-transplant surveillance.


METHODS
We analyzed 100 patients with HCC detected in the explanted liver. Monthly to bimonthly measurement of tumor markers and yearly computed tomography were scheduled postoperatively.


RESULTS
Preoperatively, 82 met the Milan criteria. The histological findings indicated that 61 fulfilled the Milan criteria. In nine patients, HCC recurred 10 months (2-29) after liver transplantation in the graft (n = 1), lung (n = 2), bone (n = 3) and multiple organs (n = 3). In all nine recipients, HCC was first suspected based on an increase in tumor marker levels. Recurrent HCC was confirmed by computed tomography (n = 7) or magnetic resonance imaging (n = 2) within 4 months (0-6) after first identifying an increase in the tumor marker levels. Six cases were treated surgically, two of which achieved prolonged survival of 16 and 38 months.


CONCLUSIONS
Frequent measurement of alpha-fetoprotein and des-gamma carboxy prothrombin was useful for detecting recurrent HCC and may be useful long-term follow-up markers for post-transplant surveillance.
Yamashiki
Noriyo
N
Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
Sugawara
Yasuhiko
Y
Tamura
Sumihito
S
Tateishi
Ryosuke
R
Yoshida
Haruhiko
H
Kaneko
Junichi
J
Matsui
Yuichi
Y
Togashi
Junichi
J
Akahane
Masaaki
M
Makuuchi
Masatoshi
M
Omata
Masao
M
Kokudo
Norihiro
N