title: Usefulness of preoperative C-reactive protein and alpha-fetoprotein levels for prognostication of patients with hepatocellular carcinoma after living donor liver transplantation.
abstract: OBJECTIVE
  The C-reactive protein level has been reported as a prognostic predictor for hepatocellular carcinoma after surgery. We investigated the usefulness of preoperative C-reactive protein levels in predicting outcomes after living donor liver transplantation for hepatocellular carcinoma and identified preoperative risk factors.
  
  
  METHODS
  We retrospectively analyzed 96 hepatocellular carcinoma patients who underwent living donor liver transplantation in March 2003-November 2009. The effect of preoperative variables on overall survival was evaluated by multivariate analysis.
  
  
  RESULTS
  The 5-year overall survival rate was significantly lower for C-reactive protein levels >0.3 mg/dL than for C-reactive protein levels ≤0.3 mg/dL (55.8% vs. 89.8%; P=0.001). In multivariate analysis, C-reactive protein levels >0.3 mg/dL (P=0.006) and alpha-fetoprotein levels >200 ng/mL (P<0.001) were significant risk factors for survival. For patients within Milan criteria (n=68), the 3-year overall survival rate with 2 risk factors (n=8) was 20%; of these patients, 63% experienced recurrence. For patients outside Milan criteria (n=28), the 5-year overall survival rate without 1-2 risk factors (n=21) was 80.9%; of these patients, 33% experienced recurrence.
  
  
  CONCLUSIONS
  Preoperative C-reactive protein levels predicted prognosis after living donor liver transplantation for hepatocellular carcinoma. C-reactive protein and alpha-fetoprotein levels together with Milan criteria may improve hepatocellular carcinoma patient selection for liver transplantation.
authors.forename: Shozo
authors.initials: S
authors.lastname: Mori
authors.forename: Youngrok
authors.initials: Y
authors.lastname: Choi
authors.forename: Min-Su
authors.initials: MS
authors.lastname: Park
authors.forename: Hyeyoung
authors.initials: H
authors.lastname: Kim
authors.forename: Geun
authors.initials: G
authors.lastname: Hong
authors.forename: Nam-Joon
authors.initials: NJ
authors.lastname: Yi
authors.forename: Kwang-Woong
authors.initials: KW
authors.lastname: Lee
authors.forename: Kyung-Suk
authors.initials: KS
authors.lastname: Suh
mesh_terms: D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis*; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011379:Prognosis; D015996:Survival Rate; D000509:alpha-Fetoproteins / Q000032:analysis*
chemical_list: D000509:alpha-Fetoproteins; D002097:C-Reactive Protein