10th Japan-Korea transplantation forumLiver transplantationPretransplant Serum Levels of C-Reactive Protein Predict Prognoses in Patients Undergoing Liver Transplantation for Hepatocellular Carcinoma

•CRP levels may be an independent predictor in patients undergoing LT for HCC.•CRP levels indicated a significantly worse outcome in patients beyond the Milan criteria.•CRP levels can provide information in selecting LT for HCC in patients exceeding the Milan criteria.

BackgroundPreoperative absolute C-reactive protein (CRP) has been shown to correlate with prognoses in various malignancies, including hepatocellular carcinoma (HCC).MethodsThe aim of this study was to investigate whether pretransplant CRP levels predict prognoses in patients undergoing liver transplantation (LT) for HCC. We retrospectively analyzed clinicopathological factors in 211 patients with available pretransplant serum CRP levels who underwent LT for HCC between January 2005 and April 2012.ResultsBy means of receiver operating characteristic curve analysis, a CRP level of >0.3 mg/dL was considered to be elevated. By multivariate analysis, the high CRP level, the maximal tumor size >5 cm, the presence of intrahepatic metastasis, and positive findings in pretransplant 18fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) were related to tumor recurrence, whereas the high CRP level, the presence of intrahepatic metastasis, and positive findings in pretransplant 18F-FDG PET/CT were related to poor overall survival. When subgroup analysis was conducted according to the Milan criteria, the high CRP level was an independent factor for predicting poor outcomes in patients with HCC beyond the Milan criteria (P = .001 for recurrence-free survival and P = .010 for overall survival), and not for patients within the criteria.ConclusionsPretransplant serum CRP levels can predict prognoses in patients undergoing LT for HCC, especially in patients with HCC exceeding the Milan criteria.