Reply to: "Incorporating AFP-L3 and DCP in selecting patients with hepatocellular carcinoma for liver transplantation: What are the optimal criteria?"

We read with great interest the current issue by Norman JS et al. regarding the analysis of AFP-L3 and DCP in predicting early hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT). [1] Norman J.S. Li P.J. Kotwani P. Shui A.M. Yao F. Mehta N. AFP-L3 and DCP Strongly Predict Early Hepatocellular Carcinoma Recurrence After Liver Transplantation. J Hepatol. 2023; S0168-8278 (05074-2)https://doi.org/10.1016/j.jhep.2023.08.020 Abstract Full Text Full Text PDF Google Scholar The authors prospectively evaluated a total of 285 HCC patients who received LT and compared the recurrence-free survival by different thresholds of AFP, AFP-L3 and DCP level. Surprisingly, 18 patients suffered HCC recurrence and AFP-L3 and DCP outperformed at predicting early HCC recurrence than AFP with C-statistics of 0.81 and 0.86, compared to 0.74 for AFP. The results are important to identify patients with high-risk of early HCC recurrence and may help further refine LT eligibility criteria. AFP-L3 and DCP strongly predict early hepatocellular carcinoma recurrence after liver transplantationJournal of HepatologyPreviewAlpha-fetoprotein (AFP) predicts hepatocellular carcinoma (HCC) recurrence after liver transplant (LT) but remains an imperfect biomarker. The role of DCP (des-gamma-carboxyprothrombin) and AFP-L3 (AFP bound to Lens culinaris agglutinin) in predicting HCC recurrence remains incompletely characterized. AFP-L3 and DCP could identify patients at high risk of post-transplant HCC recurrence and serve as liver transplant exclusion criteria to defer transplant until patients receive additional risk-reducing pre-transplant locoregional therapy. Full-Text PDF