Usefulness of Preoperative C-Reactive Protein and Alpha-Fetoprotein Levels for Prognostication of Patients with Hepatocellular Carcinoma after Living Donor Liver Transplantation

Background/Aims: The C-reactive protein level has been reported as a prognostic predictor for hepatocellular carcinoma after surgery We investigated the usefulness of preoperative C-reactive protein levels in predicting outcomes after living donor liver transplantation for hepatocellular carcinoma and identified preoperative risk factors. Methodology: We retrospectively analyzed 96 hepatocellular carcinoma patients who underwent living donor liver transplantation in March 2003-November 2009. The effect of preoperative variables on overall survival was evaluated by multivariate analysis. Results: The 5-year overall survival rate was significantly lower for C-reactive protein levels >0.3mg/dL than for C-reactive protein levels <= 0.3mg/dL (55.8% vs. 89.8%; P=0.001). In multivariate analysis, C-reactive protein levels >0.3mg/dL (P=0.006) and alpha-fetoprotein levels >200ng/mL (P<0.001) were significant risk factors for survival. For patients within Milan criteria (n=68), the 3-year overall survival rate with 2 risk factors (n=8) was 20%; of these patients, 63% experienced recurrence. For patients outside Milan criteria (n=28), the 5-year overall survival rate without 1-2 risk factors (n=21) was 80.9%; of these patients, 33% experienced recurrence. Conclusions: Preoperative C-reactive protein levels predicted prognosis after living donor liver transplantation for hepatocellular carcinoma. C-reactive protein and alpha-fetoprotein levels together with Milan criteria may improve hepatocellular carcinoma patient selection for liver transplantation.