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 paper by Norman JS et al. regarding the analysis of Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein (AFP-L3) and des-carboxy prothrombin (DCP) in predicting early hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT).1 The authors prospectively evaluated a total of 285 patients with HCC 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 AFP at predicting early HCC recurrence, with C-statistics of 0.81 and 0.86, respectively, compared to 0.74 for AFP.