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Can a Dual-Positive Biomarker Model Predict Liver Cancer Recurrence After Transplantation?

By: Julia Fiederlein Cipriano, MS
Posted: Thursday, November 16, 2023

According to Neil Mehta, MD, of the University of California, San Francisco, and colleagues, a dual-biomarker combination of alpha-fetoprotein (AFP) bound to Lens culinaris agglutinin (L3; AFP-L3) and des-gamma-carboxy prothrombin (DCP) predicted the majority of early hepatocellular carcinoma recurrences in a population of patients who underwent liver transplantation. Their findings, which were published in the Journal of Hepatology, suggested the model may be used to further refine liver transplant eligibility criteria.

“AFP is used to predict hepatocellular carcinoma recurrence after liver transplantation, but it remains an imperfect biomarker,” the investigators remarked. “In this prospective study, the biomarkers DCP and AFP-L3…outperformed AFP.”

The investigators focused on 285 patients who underwent liver transplantation (within or downstaged to Milan criteria) between 2017 and 2022. At the time of surgery, the median values of AFP, AFP-L3, and DCP were 5.0 ng/mL, 6.7%, and 1.0 ng/mL, respectively. Most patients (94.7%) received locoregional therapy prior to undergoing liver transplantation.  

With a median follow-up of 3.1 years after liver transplantation, the recurrence rate was 6.3%. The overall bootstrapped time-dependent C-statistic was 0.74 for AFP, 0.81 for AFP-L3, and 0.86 for DCP. AFP-L3 values of at least 15.0% and DCP levels of at least 7.5 ng/mL jointly forecasted 61.1% of recurrences; 2.6% of patients who did not meet this threshold experienced such an outcome. The 3-year Kaplan-Meier recurrence-free survival rates were 43.7% and 97.0% in those with and without dual-biomarker elevation, respectively (P < .001).

“High-risk patients should receive additional tumor treatment prior to transplantation to optimize the use of scarce organs,” the investigators concluded.

Disclosure: For full disclosures of the study authors, visit

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