Alpha-fetoprotein as a predictor of hepatocellular carcinoma recurrence following liver transplantation

Alpha-fetoprotein (AFP) has been increasingly recognised as a valuable marker in predicting HCC recurrence post-liver transplantation. Moreover, its secretion has been associated with poor histological tumour characteristics as it reflects an aggressive tumour biological behaviour. This review aims to summarise the emerging evidence on the use of AFP either as an independent marker, or as a variable incorporated into prognostic models. For this purpose, an electronic PubMed literature search was performed. Due to the heterogeneity of the reported studies, drawing clear conclusions about the optimum AFP cut-off level to predict recurrence is difficult. Models that include AFP at different cut-offs have been shown be superior to Milan criteria in predicting disease recurrence, but need to be prospectively validated in order to confirm their prognostic value. Until more refined methods for selecting patients become available, existing evidence support the use of AFP in decision models for liver transplantation