The Impact of PIVKA-II as a Predictor of Hepatocellular Carcinoma Recurrence in Liver Transplant Recipients

Masato Fujiki, Yasutsugu Takada, Takashi Ito and Shinji Uemoto

Department of Gastrointestinal Surgery, Kyoto University

PIVKA-II is a highly specific tumor marker for hepatocellular carcinoma (HCC) and is used to detect HCC early in cirrhosis patients and to assess response to therapy and prognosis in HCC patients. The usefulness of PIVKA-II in liver transplant recipients with end-stage cirrhosis or with HCC has yet to be clarified. Materials and Methods: Subjects were 24 cirrhosis patients without HCC and 123 HCC patients undergoing liver transplantation between 1999 and 2005. Subjects were examined for the PIVKA-II distribution and its correlation with histopathological findings of HCC and prognosis. Results: We found 58% of cirrhosis patients without HCC were positive for PIVKA-II. The mean Child-Pugh and MELD scores in the PIVKA-II positive group (10.8 and 20.9 points) were significantly higher than in the negative group (p<0.05). Of patients with HCC, cumulative recurrence at 5 years was significantly higher in the group with PIVKA-II>400 mAU/ml than in those with PIVKA-II≤400 mAU/ml (60% vs. 13%, p<0.01). Multivariate analysis showed that PIVKA-II exceeding 400 mAU/ml was an independent predisposing factor for HCC recurrence (risk ratio, 5.984; p<0.01). Median PIVKA-II in patients with positive microscopic portal venous invasion was significantly higher than that in negative patients (p<0.01). Conclusions: High positive ratio of PIVKA-II in patients with cirrhosis may be due to severe liver damage. PIVKA-II is thus a highly useful tumor marker as a predisposing factor for HCC recurrence of after liver transplantation, which is closely correlated with histopathological features of HCC.

Key words
PIVKA-II, DCP, liver transplantation, hepatocellular carcinoma, cirrhosis

Reprint requests
Masato Fujiki Department of Gastrointestinal Surgery, Kyoto University
54 Kawara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507 JAPAN

Accepted
February 28, 2007

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