title: Serum vascular endothelial growth factor level in patients with hepatocellular carcinoma undergoing liver transplantation: experience of a single Western center.
abstract: BACKGROUND
  The strongest predictor of tumor relapse after liver transplantation for hepatocellular carcinoma (HCC) is vascular invasion, appreciated only on explant analysis. High serum level of vascular endothelial growth factor (VEGF) is associated with worse outcomes after resection or locoregional therapies but its role in liver transplantation remains undefined.
  
  
  OBJECTIVE
  We report the first western prospective study exploring serum VEGF in HCC liver transplant patients, correlating pre-operative serum VEGF with poor prognostic histologic features during explant analysis.
  
  
  METHODS
  Between May 2008, and June 2010, 75 HCC patients underwent liver transplantation at our institution. Serum VEGF was measured every 3 months until liver transplantation and correlated with histopathologic findings on explant.
  
  
  RESULTS
  There was no significant correlation between pre-transplant serum VEGF levels and tumor burden (median 31.0 pg/mL vs. 42.5 pg/mL, p=0.33, for tumors within and beyond the Milan criteria, respectively). Pre-transplant VEGF levels were higher in poorly differentiated tumors compared to well to moderately differentiated tumors, but not statistically significant (median 49.0 pg/mL vs. 31.0 pg/mL, p=0.26). Pre-transplant VEGF did not correlate with vascular invasion (median 37.0 pg/mL vs. 31.0 pg/mL, p=0.35, in the presence and absence of vascular invasion, respectively).
  
  
  CONCLUSIONS
  Pre-operative serum VEGF fails to predict unfavorable histologic HCC features in patients undergoing liver transplantation. Role of serum VEGF in liver transplant HCC patients remains unclear.
authors.affiliation: BC Cancer Agency-Abbotsford, BC, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Tan
authors.affiliation: Department of Solid Tumor Oncology Taussig Cancer Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: R
authors.initials: R
authors.lastname: Kim
authors.affiliation: Hepatobiliary and Liver Transplant Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: G
authors.initials: G
authors.lastname: El-Gazzaz
authors.affiliation: Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic Foundation, OH, Cleveland, Ohio, USA.
authors.forename: N
authors.initials: N
authors.lastname: Menon
authors.affiliation: Hepatobiliary and Liver Transplant Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, OH.
authors.forename: F
authors.initials: F
authors.lastname: Aucejo
keywords: Hepatocellular carcinoma; Liver transplantation; Vascular endothelial growth factor