TY - JOUR
T1 - Hepatocellular Carcinoma, Alpha Fetoprotein, and Liver Allocation for Transplantation
T2 - Past, Present and Future
AU - Ruch, Brianna
AU - Wagler, Josiah
AU - Kumm, Kayla
AU - Zhang, Chi
AU - Katariya, Nitin N.
AU - Garcia-Saenz-de-Sicilia, Mauricio
AU - Giorgakis, Emmanouil
AU - Mathur, Amit K.
N1 - Publisher Copyright:
© 2022 by the authors.
PY - 2022/10
Y1 - 2022/10
N2 - Hepatocellular carcinoma (HCC) is one of the leading indications for liver transplantation and has been the treatment of choice due to the oncologic benefit for patients with advanced chronic liver disease (AdvCLD) and small tumors for the last 25 years. For HCC patients undergoing liver transplantation, alpha fetoprotein (AFP) has increasingly been applied as an independent predictor for overall survival, disease free recurrence, and waitlist drop out. In addition to static AFP, newer studies evaluating the AFP dynamic response to downstaging therapy show enhanced prognostication compared to static AFP alone. While AFP has been utilized to select HCC patients for transplant, despite years of allocation policy changes, the US allocation system continues to take a uniform approach to HCC patients, without discriminating between those with favorable or unfavorable tumor biology. We aim to review the history of liver allocation for HCC in the US, the utility of AFP in liver transplantation, the implications of weaving AFP as a biomarker into policy. Based on this review, we encourage the US transplant community to revisit its HCC organ allocation model, to incorporate more precise oncologic principles for patient selection, and to adopt AFP dynamics to better stratify waitlist dropout risk.
AB - Hepatocellular carcinoma (HCC) is one of the leading indications for liver transplantation and has been the treatment of choice due to the oncologic benefit for patients with advanced chronic liver disease (AdvCLD) and small tumors for the last 25 years. For HCC patients undergoing liver transplantation, alpha fetoprotein (AFP) has increasingly been applied as an independent predictor for overall survival, disease free recurrence, and waitlist drop out. In addition to static AFP, newer studies evaluating the AFP dynamic response to downstaging therapy show enhanced prognostication compared to static AFP alone. While AFP has been utilized to select HCC patients for transplant, despite years of allocation policy changes, the US allocation system continues to take a uniform approach to HCC patients, without discriminating between those with favorable or unfavorable tumor biology. We aim to review the history of liver allocation for HCC in the US, the utility of AFP in liver transplantation, the implications of weaving AFP as a biomarker into policy. Based on this review, we encourage the US transplant community to revisit its HCC organ allocation model, to incorporate more precise oncologic principles for patient selection, and to adopt AFP dynamics to better stratify waitlist dropout risk.
KW - alpha fetoprotein
KW - hepatocellular carcinoma
KW - liver allocation
KW - liver transplantation
UR - http://www.scopus.com/inward/record.url?scp=85140647517&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85140647517&partnerID=8YFLogxK
U2 - 10.3390/curroncol29100593
DO - 10.3390/curroncol29100593
M3 - Review article
C2 - 36290870
AN - SCOPUS:85140647517
SN - 1198-0052
VL - 29
SP - 7537
EP - 7551
JO - Current Oncology
JF - Current Oncology
IS - 10
ER -