Letter to the Editor: Comment on Alpha-Fetoprotein Decrease From >1,000 to <500 ng/mL in Patients With Hepatocellular Carcinoma Leads to Improved Posttransplant Outcomes.

We read the recent article published by Mehta and colleagues with great interest (1). The authors state that UNOS have developed a policy of reducing the pretransplant alfa-feto protein (AFP) from 1000 to below 500 ng/ml by locoregional therapy (LRT). Although it is known fact that AFP>1000 ng/ml is a significant risk factor for recurrence even in patients with HCC within the Milan criteria, 72% of the patients in the present study have an AFP>1000 ng/ml and this point should be explained. About 76 % of the patients should have been considered for LRT prior to liver transplantation (LT) according to the UNOS criteria. On the other hand, analysis of Table 2 shows that 63.9% of the patients received LRT and in 174 patients (66.9%) AFP values did not drop below the standards determined by UNOS criteria (<500 ng/ml). Furthermore, if Table-1 and Table-2 of the article are analyzed together, it is seen that Milan criteria were only extended by 1.7%.