Abstract
PIVKA-II is a highly specific tumor marker for hepatocellular carcinoma (HCC) and is used to detect HCCearly in cirrhosis patients and to assess response to therapy and prognosis in HCC patients. The usefulness ofPIVKA-II in liver transplant recipients with end-stage cirrhosis or with HCC has yet to be clarified. Materialsand 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 correlationwith histopathological findings of HCC and prognosis. Results: We found 58% of cirrhosis patients withoutHCC 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≤400mAU/ml than inthose with PIVKA-II≤400mAU/ml (60% vs. 13%, p<0.01). Multivariate analysis showed that PIVKA-II exceeding 400mAU/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 thanthat in negative patients (p<0.01). Conclusions: High positive ratio of PIVKA-II in patients with cirrhosismay be due to severe liver damage. PIVKA-II is thus a highly useful tumor marker as a predisposing factorfor HCC recurrence of after liver transplantation, which is closely correlated with histopathological features ofHCC.
