title: Metastatic Recurrent Hepatocellular Carcinoma Post Liver Transplant With Marked Pretransplant Elevation of Alpha Fetoprotein and No Evidence of Primary Neoplasm.
abstract: Determinants of hepatocellular carcinoma recurrence posttransplant include hepatic tumor burden, presence of vascular invasion, and serum alpha-fetoprotein level. However, the significance of marked alpha-fetoprotein elevation in cirrhosis, in the absence of a hepatic mass lesion on imaging studies, is unclear and no longer qualifies for a Model for End-Stage Liver disease exception for transplant listing in the United States. We report a case of posttransplant metastatic recurrent hepatocellular carcinoma in a patient with marked elevation of alpha-fetoprotein pretransplant without imaging evidence of primary hepatic tumor before or after transplant or histopathologic evidence of neoplasm in the explant. This report underscores the significance of marked alpha-fetoprotein elevation in the setting of cirrhosis, even in the absence of a liver lesion, as it may identify a subset of patients with microvascular invasion and microscopic tumor cell dissemination placing them at high risk of posttransplant recurrence. Longer follow-up may be considered in these patients pretransplant to optimize outcomes by lowering posttransplant recurrence risk.
authors.affiliation: From the Center for Liver Disease and Transplantation, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin, USA, and the Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE.
authors.forename: Shiva
authors.initials: S
authors.lastname: Kumar
mesh_terms: D001706:Biopsy; D001859:Bone Neoplasms / Q000097:blood / Q000556:secondary*; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery*; D018450:Disease Progression; D017809:Fatal Outcome; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008113:Liver Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D008175:Lung Neoplasms / Q000097:blood / Q000556:secondary*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D013160:Splenic Neoplasms / Q000097:blood / Q000556:secondary*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D015854:Up-Regulation; D000509:alpha-Fetoproteins / Q000378:metabolism*
chemical_list: C097353:AFP protein, human; D000509:alpha-Fetoproteins