α-胎儿蛋白(AFP)在肝移植后预测肝细胞癌(HCC)的复发，但仍然是一个不完美的生物标记物。 DCP (去γ-羧基凝血酶原)和AFP-L3 (与适合红豆凝集素结合的AFP)在预测HCC复发方面的作用仍未完全明确。 AFP-L3和DCP可以识别出高风险的移植后HCC复发患者，并作为肝移植排除标准，推迟移植直到患者接受额外的降低风险的移植前局部区域疗法。 本前瞻性队列研究包括2017年至2022年间接受LT(符合米兰标准或术前下标)的连续HCC患者。获取术前AFP、AFP-L3和DCP测量数据。主要终点是生物标记物预测HCC复发的无病生存能力。 本队列共包括285例患者，中位年龄为67岁(IQR 63-71)。在LT时，中位生物标记物值分别为AFP 5.0 ng/mL (IQR 3.0-12.1)，AFP-L3 6.7% (0.5-13.2)，DCP 1.0 ng/mL (0.3-2.8)。大多数(94.7%)患者在LT前接受术前局部区域疗法(LRT)。在中位LT后的3.1年的随访中，18例(6.3%)患者出现HCC复发。 AFP-L3和DCP的C-统计量分别为0.81和0.86，而AFP为0.74，前两者优于AFP。AFP-L3 ≥15%和DCP ≥7.5的双生物标记物组合预测了61.1%的HCC复发，而在265名未达到此阈值的患者中，只有7例(2.6%)复发。术后3年Kaplan-Meier复发生存率为双阳性生物标记物患者为43.7%，其余患者为97.0% (p<0.001)。 AFP-L3 ≥15%和DCP ≥7.5的双阳性强烈预测了LT后的HCC复发。该模型可以优化LT的选择标准，并识别高风险的HCC患者，在生物标记物下降之前将LT推迟。版权所有 © 2023年欧洲肝脏研究协会。由Elsevier B.V.出版。保留所有权利。

Alpha-fetoprotein (AFP) predicts hepatocellular carcinoma (HCC) recurrence after liver transplant (LT) but remains an imperfect biomarker. The role of DCP (des-gamma-carboxyprothrombin) and AFP-L3 (AFP bound to Lens culinaris agglutinin) in predicting HCC recurrence remains incompletely characterized. AFP-L3 and DCP could identify patients at high risk of post-transplant HCC recurrence and serve as liver transplant exclusion criteria to defer transplant until patients receive additional risk-reducing pre-transplant local regional therapy.This prospective cohort study included consecutive HCC patients who underwent LT (within or down-staged to Milan criteria) between 2017 and 2022. Pre-transplant AFP, AFP-L3, and DCP measurements were obtained. The primary endpoint was the ability of biomarkers to predict HCC recurrence-free survival.This cohort included 285 patients with a median age of 67 (IQR 63-71). At LT, median biomarker values were AFP 5.0 ng/mL (IQR 3.0-12.1), AFP-L3 6.7% (0.5-13.2), and DCP 1.0 ng/mL (0.3-2.8). Most (94.7%) patients received pre-LT local regional therapy (LRT). After a median post-LT follow-up of 3.1 years, HCC recurrence was observed in 18 (6.3%) patients. AFP-L3 and DCP outperformed AFP with C-statistics of 0.81 and 0.86 respectively, compared with 0.74 for AFP. A dual-biomarker combination of AFP-L3 ≥15% and DCP ≥7.5 predicted 61.1% of HCC recurrences whereas among 265 patients not meeting this threshold, only 7 (2.6%) recurred. The Kaplan-Meier recurrence-free survival at 3 years post-LT was 43.7% for patients with dual-positive biomarkers compared to 97.0% for all others (p<0.001).Dual-positivity for AFP-L3 ≥15% and DCP ≥7.5 strongly predicted post-LT HCC recurrence. This model could refine LT selection criteria and identify high-risk HCC patients to receive additional LRT with LT on hold until biomarker reduction is achieved.Copyright © 2023 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.