The GALAD score allows early detection of recurrent hepatocellular carcinoma after orthotopic liver transplantation

Background and Aims Recurrence of hepatocellular carcinoma (HCC) after orthotopic liver transplantation (OLT) has an unfavourable prognosis. The potential of novel HCC biomarkers for prediction and early detection of HCC recurrence after OLT is not established. We have assessed the value of the GALAD score for detection and prediction of HCC recurrence after OLT.

Method In this retrospective monocentric study all patients who underwent OLT due to HCC between 2010 and 2020 in one University Hospital were included. Inclusion criteria were diagnosis of HCC by radiologic or histologic criteria before OLT, availability of serum for biomarker measurement before OLT, 6, 12 and 24 months after OLT, follow-up for at least two years or until HCC recurrence after OLT and written informed consent. Alpha-fetoprotein (AFP), alpha-fetoprotein-L3 (AFP-L3) and des-carboxy-prothrombin (DCP) were measured by µTASWako i30 test system. The GALAD score was calculated as previously published. Imaging within 5 years after OLT was performed every 6 months using abdominal ultrasound alternating with abdominal magnetic resonance imaging plus thoracic contrast enhanced computed tomography.

Results A total of 77 patients was enrolled. The mean observation time was 68±44 (range 2 – 144) months. HCCR was diagnosed in 20 patients after a mean period of 32±30 (1 – 104) months. The median recurrence free survival after OLT was 135 months (95% CI: 126, 144 months). The GALAD score before OLT was associated with the number of HCC nodules (p=0.009), with HCC grading (p=0.025) and total HCC diameter in the explanted liver (p=0.004). GALAD score correlated negatively with the time between first diagnosis of HCC recurrence and OLT (p=0.047). Regular determination of the GALAD score within the first two years after OLT showed a positive score (cut-off value of -1.55) in 8 of the 9 patients with HCC recurrence. GALAD score became positive on average 2.13±3.5 (0 – 10) months before radiological diagnosis of HCC recurrence. The mean GALAD score was higher before OLT in patients with early HCC recurrence diagnosed within 6 months of OLT (n=4), as compared to those with late or no HCC recurrence or (2.23±2.1 (0.84 – 4.61) vs -0.97±2.6 (-5.88 – 11.21); p=0.02) ([Abb. 1]).

Abb. 1  

Conclusion The GALAD score may be a useful tool to improve the prediction and early diagnosis of HCC recurrence after OLT.

 

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Publikationsverlauf

Artikel online veröffentlicht:
28. August 2023