For some liver cancer patients, their best hope for a cure is a new liver; however, with hundreds of thousands of new cases worldwide each year, the need for healthy donor livers far exceeds the supply. With so few livers available for transplant, ensuring each match is successful becomes especially important.
Clinical researchers in City of Hope’s departments of Surgery and Population Sciences recently teamed with colleagues at Cedars-Sinai Medical Center in Los Angeles to test if a key protein could help predict the odds of success for liver transplant to treat liver cancer. Their results appeared in the January issue of Archives of Surgery.
Using the United Network of Organ Sharing database, the team studied the records of 2,253 liver cancer patients who had undergone liver transplant, the replacement of a diseased liver with a whole, healthy liver.
The researchers checked patients’ pretransplant blood levels of a protein called alpha-fetoprotein, or AFP, and weighed those against treatment outcomes.
“We found that patients who had elevated serum AFP levels prior to transplant were less likely to survive in the years after transplant than those with lower AFP levels,” said Joseph Kim, M.D., associate professor of surgery.
The team divided the patients into three groups based on blood levels of AFP: low, medium and high. Patients in the low group had a 76 percent overall chance of surviving four years after transplant compared to 65 percent for medium-AFP patients. High-AFP patients fared the worst, with just 57 percent survival.
Because of the scant supply of healthy donor livers, transplant physicians recognize the need to improve the criteria used to qualify patients for liver transplant. However, the idea of passing over patients who may have a poor prognosis raises controversy, since reliable methods of determining who will benefit most from the procedure remain elusive.
“Our results suggest that AFP might be a useful biomarker for helping to determine the best way to allocate a severely limited supply of donated livers,” Kim said. This could bring some clarity to a controversial topic, but more research to confirm the usefulness of AFP blood levels, as well as other methods, is needed, he added.
Additional researchers on the study include Brian Mailey, M.D., Avo Artinyan, M.D., M.S., Joshua Khalili, Jordan Denitz, Nicelio Sanchez-Luege, Can-Lan Sun, M.D., Ph.D., Smita Bhatia, M.D., M.P.H., Nicholas Nissen, M.D., and Steven D. Colquhoun, M.D.