Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jul 28, 2015; 7(15): 1899-1904
Published online Jul 28, 2015. doi: 10.4254/wjh.v7.i15.1899
Selection tool alpha-fetoprotein for patients waiting for liver transplantation: How to easily manage a fractal algorithm
Quirino Lai, Giovanni Battista Levi Sandri, Jan Lerut
Quirino Lai, Transplant Unit, Department of Surgery, University Aquila, San Salvatore Hospital, 67010 Aquila, Italy
Quirino Lai, Jan Lerut, Starzl Unit Abdominal Transplantation, University Hospitals Saint Luc, Université catholique Louvain, 1348 Brussels, Belgium
Giovanni Battista Levi Sandri, Department of General Surgery and Organ Transplantation, Umberto I Hospital, Sapienza University, 00185 Rome, Italy
Author contributions: Lai Q designed the research; Lai Q and Lerut J wrote the paper; Lai Q, Levi Sandri GB and Lerut J participated in the critical evaluation of the paper.
Conflict-of-interest statement: None of the authors has any conflict of interest to declare in relation to this study.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Quirino Lai, MD, Transplant Unit, Department of Surgery, University Aquila, San Salvatore Hospital, Via Vetoio 1, 67010 Aquila, Italy. lai.quirino@libero.it
Telephone: +39-08-62368256 Fax: +39-08-62368254
Received: January 1, 2015
Peer-review started: January 2, 2015
First decision: January 20, 2015
Revised: June 9, 2015
Accepted: June 15, 2015
Article in press: June 16, 2015
Published online: July 28, 2015
Core Tip

Core tip: Alpha-fetoprotein (AFP) behavior in patients with hepatocellular carcinoma waiting for liver transplant (LT) represents a perfect example of a fractal model. Consequently, AFP represents a useful but poorly manageable selection tool for patients waiting for LT. Looking at the recent literature, we can assume that: (1) last AFP value seem to be the best values to adopt; (2) different cut-offs may be adopted in the two different scenarios of Milan Criteria (MC) IN and MC OUT status; (3) AFP cut-off of 1000 ng/mL represent a good compromise for MC-IN patients; and (4) no definitive conclusion has been reached in relation to MC-OUT patients.