title: Liver transplantation for hepatocellular carcinoma: evaluation of the alpha-fetoprotein model in a multicenter cohort from Latin America.
abstract: The French alpha-fetoprotein (AFP) model has recently shown superior results compared to Milan criteria (MC) for prediction of hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT) in European populations. The aim of this study was to explore the predictive capacity of the AFP model for HCC recurrence in a Latin-American cohort.
  
  
  
  Three hundred twenty-seven patients with HCC were included from a total of 2018 patients transplanted at 15 centres. Serum AFP and imaging data were both recorded at listing. Predictability was assessed by the Net Reclassification Improvement (NRI) method.
  
  
  
  Overall, 82 and 79% of the patients were within MC and the AFP model respectively. NRI showed a superior predictability of the AFP model against MC. Patients with an AFP score >2 points had higher risk of recurrence at 5 years Hazard Ratio (HR) of 3.15 (P = 0.0001) and lower patient survival (HR = 1.51; P = 0.03). Among patients exceeding MC, a score ≤2 points identified a subgroup of patients with lower recurrence (5% vs 42%; P = 0.013) and higher survival rates (84% vs 45%; P = 0.038). In cases treated with bridging procedures, following restaging, a score >2 points identified a higher recurrence (HR 2.2, P = 0.12) and lower survival rate (HR 2.25, P = 0.03). A comparative analysis between HBV and non-HBV patients showed that the AFP model performed better in non-HBV patients.
  
  
  
  The AFP model could be useful in Latin-American countries to better select patients for LT in subgroups presenting with extended criteria. However, particular attention should be focused on patients with HBV.
authors.affiliation: Hospital Universitario Austral, Pilar, Argentina. fpinerof@cas.austral.edu.ar.
authors.forename: Federico
authors.initials: F
authors.lastname: Piñero
authors.affiliation: Hospital Universitario Austral, Pilar, Argentina.
authors.forename: Matías
authors.initials: M
authors.lastname: Tisi Baña
authors.affiliation: Hospital de Clinicas, State University of Campinas, Campinas, Brazil.
authors.forename: Elaine Cristina
authors.initials: EC
authors.lastname: de Ataide
authors.affiliation: Hospital Pablo Tobón Uribe, Medellin, Colombia.|Universidad de Antioquía, Medellin, Colombia.
authors.forename: Sergio
authors.initials: S
authors.lastname: Hoyos Duque
authors.affiliation: Hospital Italiano from Buenos Aires, Buenos Aires, Argentina.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Marciano
authors.affiliation: Fundación Cardioinfantil, Instituto de Cardiología, Bogotá, Colombia.
authors.forename: Adriana
authors.initials: A
authors.lastname: Varón
authors.affiliation: Hospital Alemán, Buenos Aires, Argentina.
authors.forename: Margarita
authors.initials: M
authors.lastname: Anders
authors.affiliation: Sanatorio Allende from Córdoba, Córdoba, Argentina.
authors.forename: Alina
authors.initials: A
authors.lastname: Zerega
authors.affiliation: Hospital Militar-Clínicas, Montevideo, Uruguay.
authors.forename: Josemaría
authors.initials: J
authors.lastname: Menéndez
authors.affiliation: Clinica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile.|Hospital del Salvador, Universidad de Chile, Santiago, Chile.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Zapata
authors.affiliation: Hospital Universitario de Monterrey, Monterrey, Mexico.
authors.forename: Linda
authors.initials: L
authors.lastname: Muñoz
authors.affiliation: Hospital Guillermo Almenara, Lima, Perú.
authors.forename: Martín
authors.initials: M
authors.lastname: Padilla Machaca
authors.affiliation: Hospital Universidad Católica de Chile, Santiago, Chile.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Soza
authors.affiliation: Hospital Alemán, Buenos Aires, Argentina.
authors.forename: Lucas
authors.initials: L
authors.lastname: McCormack
authors.affiliation: Hospital Clínico Universidad de Chile, Santiago, Chile.
authors.forename: Jaime
authors.initials: J
authors.lastname: Poniachik
authors.affiliation: Hospital Universitario Austral, Pilar, Argentina.
authors.forename: Luis G
authors.initials: LG
authors.lastname: Podestá
authors.affiliation: Hospital Italiano from Buenos Aires, Buenos Aires, Argentina.
authors.forename: Adrian
authors.initials: A
authors.lastname: Gadano
authors.affiliation: Hospital de Clinicas, State University of Campinas, Campinas, Brazil.
authors.forename: Ilka S F Fatima
authors.initials: IS
authors.lastname: Boin
authors.affiliation: Henri Mondor Hospital, University of Paris-Est, Creteil, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Duvoux
authors.affiliation: Hospital Universitario Austral, Pilar, Argentina.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Silva
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000601:surgery; D005260:Female; D006801:Humans; D007843:Latin America; D008113:Liver Neoplasms / Q000097:blood* / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000401:mortality; D012189:Retrospective Studies; D016019:Survival Analysis; D000509:alpha-Fetoproteins / Q000032:analysis*
chemical_list: D000509:alpha-Fetoproteins
keywords: alpha-fetoprotein; candidate selection; liver cancer; prediction