title: Postoperative surveillance with monthly serum tumor markers after living-donor liver transplantation for hepatocellular carcinoma.
abstract: 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.
authors.affiliation: 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.
authors.forename: Noriyo
authors.initials: N
authors.lastname: Yamashiki
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Sugawara
authors.forename: Sumihito
authors.initials: S
authors.lastname: Tamura
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Tateishi
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Yoshida
authors.forename: Junichi
authors.initials: J
authors.lastname: Kaneko
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Matsui
authors.forename: Junichi
authors.initials: J
authors.lastname: Togashi
authors.forename: Masaaki
authors.initials: M
authors.lastname: Akahane
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Makuuchi
authors.forename: Masao
authors.initials: M
authors.lastname: Omata
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kokudo