Albumin mRNA in plasma predicts post-transplant recurrence of patients with hepatocellular carcinoma

Background. Currently, hepatocellular carcinoma (HCC) patients are selected for liver transplantation based on radiological assessment (size and number of tumor nodules) and/or pathological features (tumor grade and vascular invasion). The former criteria have limited power on prognosis, whereas the latter do not provide complete information until explant is available. Methods. This study aims to investigate whether quantitative measurement of plasma mRNA derived from cancer can provide preoperative prognostic information. Preoperative plasma samples obtained from 72 HCC patients who had undergone liver transplantation were studied. The patients were selected for liver transplantation largely based on the Milan criteria before 2002 and UCSF criteria after 2002. Real-time quantitative reverse transcriptase polymerase chain reaction with Taqman system was used to measure the albumin mRNA levels in plasma. Results. Fifteen patients (21%) had HCC recurrences. Patients with a high plasma albumin mRNA level (> 14.6) had a significantly higher recurrence rate (log-rank test, P=0.001). High plasma albumin mRNA level predicted 2-year HCC recurrence with sensitivity and specificity of 73% and 70%, respectively. By multivariate analysis, plasma albumin mRNA level (adjusted hazard ratio=5.9, P=0.002) and vascular invasion (adjusted hazard ratio=6.0, P=0.001) were the only independent risk factors for prediction of HCC recurrence. Conclusions. Plasma albumin mRNA quantification predicts posttransplant HCC recurrence. It may supplement the current selection criteria of HCC patients for liver transplantation.