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Serum Alpha-Fetoprotein as a Biomarker in Liver Transplantation

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Biomarkers in Liver Disease

Abstract

Alpha-fetoprotein (AFP) is one of the most widely tested biomarkers in medicine. It has long been used in surveillance and diagnosis of hepatocellular carcinoma (HCC), the second cause of cancer-related death worldwide. Modern imaging modalities have replaced AFP in screening and diagnosis of HCC in the last decade. However, the establishment of liver transplantation as the gold standard treatment for HCC patients brought AFP back to the focus of interest. AFP was thoroughly investigated as a selection criterion for transplant candidates and a potential predictor of posttransplant HCC recurrence and survival. The general conclusion that can be made from all the studies is that high or rising AFP values indicate aggressive tumor biology and correlate with poor differentiation, microvascular invasion, posttransplant HCC recurrence, and reduced survival. Different AFP cutoff values were proposed, with or without being incorporated into transplant selection criteria or prognostic models. Because of the wide range of the proposed AFP cutoff values (from 15 to 1000 ng/nL) and the major diversity of the suggested selection criteria and prognostic models, there is no universal agreement on a specific role for AFP in liver transplantation till now. Prospective validation of AFP roles in large well-conducted randomized trials needs to be performed to come up with definite conclusions that can be applied to clinical practice. Also, multiple new biological and genetic markers are being studied in surveillance and diagnosis of HCC with promising results.

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Abbreviations

AASLD:

American Association for the Study of Liver Diseases

AFP:

Alpha-fetoprotein

AFP-L3:

Lens culinaris agglutinin-reactive alpha-fetoprotein

APASL:

Asian Pacific Association for the Study of the Liver

CT:

Computerized tomography

DCP:

Des-gamma carboxyprothrombin

DeMELD:

Dropout equivalent MELD

EASL:

European Association for the Study of the Liver

HCC:

Hepatocellular carcinoma

kDa::

Kilodalton

LRT:

Locoregional treatment

MELD:

Model for end-stage liver disease

mRECIST:

Modified response evaluation criteria in solid tumors

MRI:

Magnetic resonance imaging

NAS:

Natural AFP slope

NCCN:

National comprehensive cancer network

PEI:

Percutaneous ethanol injection

PIVKA-II:

Protein induced by vitamin K absence or deficiency

RFA:

Radio-frequency ablation

TACE:

Transarterial chemoembolization

TARE:

Transarterial radio-embolization

TTD:

Total tumor diameter

TTV:

Total tumor volume

UCSF:

University of California San Francisco

UNOS:

United Network for Organ Sharing

US:

Ultrasound

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  1. Department of Hepatobiliary Surgery and Liver Transplantation, National Liver Institute, Minufiya University, Shebin Elkoom, Minufiya, Egypt

    Samy Kashkoush & Sherif Saleh

  2. Organ Transplant Center, King Abdullah Specialist Children Hospital (KASCH) National Guard, MC: 1953, 22490, 11426, Riyadh, Saudi Arabia

    Samy Kashkoush

  3. Hepatobiliary and Liver Transplant Surgery, Hamad Medical Corporation (HMC), Doha, Qatar

    Walid Elmoghazy

Authors
  1. Samy Kashkoush
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  2. Sherif Saleh
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  3. Walid Elmoghazy
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Corresponding authors

Correspondence to Samy Kashkoush , Sherif Saleh or Walid Elmoghazy .

Editor information

Editors and Affiliations

  1. Department of Biomedical Science, Faculty of Science and Technology, University of Westminster, London, United Kingdom

    Vinood B. Patel

  2. Diabetes and Nutritional Sciences Research Division, Faculty of Life Science and Medicine, King’s College London, London, United Kingdom

    Victor R. Preedy

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© 2017 Springer Science+Business Media Dordrecht

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Kashkoush, S., Saleh, S., Elmoghazy, W. (2017). Serum Alpha-Fetoprotein as a Biomarker in Liver Transplantation. In: Patel, V., Preedy, V. (eds) Biomarkers in Liver Disease. Biomarkers in Disease: Methods, Discoveries and Applications. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-7675-3_34

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