Prothrombin-induced by vitamin K absence II as a prognostic factor in living donor liver transplantation for hepatocellular carcinoma
Abstract In hepatocellular carcinoma (HCC), there is a need for novel tumor markers to enhance patient selection for liver transplantation. This study evaluates the prognostic value of Prothrombin Induced by Vitamin K Absence-II (PIVKA-II) in predicting microvascular invasion (MVI) and post-transpla...
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Nature Portfolio
2025-07-01
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| Series: | Scientific Reports |
| Online Access: | https://doi.org/10.1038/s41598-025-08103-1 |
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| author | Abu Bakar Hafeez Bhatti Usman Shafique Nazish Ahmed Ghazanfar Abbas Muslim Atiq Haseeb Haider Zia Nusrat Yar Khan Atif Rana |
| author_facet | Abu Bakar Hafeez Bhatti Usman Shafique Nazish Ahmed Ghazanfar Abbas Muslim Atiq Haseeb Haider Zia Nusrat Yar Khan Atif Rana |
| author_sort | Abu Bakar Hafeez Bhatti |
| collection | DOAJ |
| description | Abstract In hepatocellular carcinoma (HCC), there is a need for novel tumor markers to enhance patient selection for liver transplantation. This study evaluates the prognostic value of Prothrombin Induced by Vitamin K Absence-II (PIVKA-II) in predicting microvascular invasion (MVI) and post-transplant recurrence, either alone or in combination with alpha-fetoprotein (AFP), following living donor liver transplantation (LDLT). We reviewed 400 patients who underwent LDLT under expanded criteria (largest tumor diameter ≤ 10 cm, any tumor number, AFP < 1000 ng/ml). PIVKAII outperformed AFP and tumor size in predicting MVI, with a C-statistic of 0.777 compared to 0.579 and 0.631. On multivariate analysis, AFP > 20 ng/ml [HR 3.3, P = 0.003] and PIVKAII > 1000 mAU/ml [HR 3.5, P = 0.001] were predictors of recurrence. PIVKAII > 1000 mAU/ml was associated with MVI (21.6% vs. 65.7%, P < 0.001) and lower 5-year RFS (79% vs. 50%, P < 0.001). A combination of AFP > 20 ng/ml and PIVKAII > 1000 mAU/ml predicted 47.1% of recurrences, whereas HCC recurred in 6.1% of patients not meeting this threshold. The 5-year RFS was 45% for dual tumor marker positive HCC versus 77% for all others (P < 0.001). PIVKAII is a strong predictor of MVI and post-transplant recurrence. Dual tumor marker-positive HCC can serve as an exclusion criterion for upfront LDLT. |
| format | Article |
| id | doaj-art-24f55e02aa32437a8fdad4304c058d38 |
| institution | Kabale University |
| issn | 2045-2322 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Scientific Reports |
| spelling | doaj-art-24f55e02aa32437a8fdad4304c058d382025-08-20T03:45:26ZengNature PortfolioScientific Reports2045-23222025-07-011511810.1038/s41598-025-08103-1Prothrombin-induced by vitamin K absence II as a prognostic factor in living donor liver transplantation for hepatocellular carcinomaAbu Bakar Hafeez Bhatti0Usman Shafique1Nazish Ahmed2Ghazanfar Abbas3Muslim Atiq4Haseeb Haider Zia5Nusrat Yar Khan6Atif Rana7Department of HPB Surgery and Liver Transplantation , Shifa International Hospital Islamabad Department of HPB Surgery and Liver Transplantation , Shifa International Hospital Islamabad Department of HPB Surgery and Liver Transplantation , Shifa International Hospital Islamabad Department of Pathology , Shifa International Hospital Islamabad Department of Gastroenterology and Hepatology , Shifa International Hospital Islamabad Department of HPB Surgery and Liver Transplantation , Shifa International Hospital Islamabad Department of HPB Surgery and Liver Transplantation , Shifa International Hospital Islamabad Department of Radiology , Shifa International Hospital Islamabad Abstract In hepatocellular carcinoma (HCC), there is a need for novel tumor markers to enhance patient selection for liver transplantation. This study evaluates the prognostic value of Prothrombin Induced by Vitamin K Absence-II (PIVKA-II) in predicting microvascular invasion (MVI) and post-transplant recurrence, either alone or in combination with alpha-fetoprotein (AFP), following living donor liver transplantation (LDLT). We reviewed 400 patients who underwent LDLT under expanded criteria (largest tumor diameter ≤ 10 cm, any tumor number, AFP < 1000 ng/ml). PIVKAII outperformed AFP and tumor size in predicting MVI, with a C-statistic of 0.777 compared to 0.579 and 0.631. On multivariate analysis, AFP > 20 ng/ml [HR 3.3, P = 0.003] and PIVKAII > 1000 mAU/ml [HR 3.5, P = 0.001] were predictors of recurrence. PIVKAII > 1000 mAU/ml was associated with MVI (21.6% vs. 65.7%, P < 0.001) and lower 5-year RFS (79% vs. 50%, P < 0.001). A combination of AFP > 20 ng/ml and PIVKAII > 1000 mAU/ml predicted 47.1% of recurrences, whereas HCC recurred in 6.1% of patients not meeting this threshold. The 5-year RFS was 45% for dual tumor marker positive HCC versus 77% for all others (P < 0.001). PIVKAII is a strong predictor of MVI and post-transplant recurrence. Dual tumor marker-positive HCC can serve as an exclusion criterion for upfront LDLT.https://doi.org/10.1038/s41598-025-08103-1 |
| spellingShingle | Abu Bakar Hafeez Bhatti Usman Shafique Nazish Ahmed Ghazanfar Abbas Muslim Atiq Haseeb Haider Zia Nusrat Yar Khan Atif Rana Prothrombin-induced by vitamin K absence II as a prognostic factor in living donor liver transplantation for hepatocellular carcinoma Scientific Reports |
| title | Prothrombin-induced by vitamin K absence II as a prognostic factor in living donor liver transplantation for hepatocellular carcinoma |
| title_full | Prothrombin-induced by vitamin K absence II as a prognostic factor in living donor liver transplantation for hepatocellular carcinoma |
| title_fullStr | Prothrombin-induced by vitamin K absence II as a prognostic factor in living donor liver transplantation for hepatocellular carcinoma |
| title_full_unstemmed | Prothrombin-induced by vitamin K absence II as a prognostic factor in living donor liver transplantation for hepatocellular carcinoma |
| title_short | Prothrombin-induced by vitamin K absence II as a prognostic factor in living donor liver transplantation for hepatocellular carcinoma |
| title_sort | prothrombin induced by vitamin k absence ii as a prognostic factor in living donor liver transplantation for hepatocellular carcinoma |
| url | https://doi.org/10.1038/s41598-025-08103-1 |
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