Selection tool alpha-fetoprotein for patients waiting for liver transplantation: How to easily manage a fractal algorithm

Table 1 Recent articles focused on alpha-fetoprotein static values

Ref.	Year	n	Country	Cut-off value(ng/mL)
McHugh et al[12]	2010	101	United States	100
Grąt et al[13]	2014	121	Poland	100
Abdel-Wahab et al[14]	2013	170 (LDLT)	Egypt	200
Lai et al[15]	2011	153	Italy	210
Harimoto et al[16]	2013	167 (LDLT)	Japan	300
Merani et al[6]	2011	6817	United States	400
Toso et al[7]	2009	6478	United States	400
Zheng et al[8]	2008	195	China	400
Lai et al[9]	2012	158	Italy	400
Ciccarelli et al[10]	2012	137	Belgium	400
Wong et al[11]	2013	211	United States	400
Yang et al[17]	2007	63 (LDLT)	South Korea	1000
Zou et al[18]	2008	303	China	1000
Duvoux et al[19]	2012	435	France	1000
Hameed et al[20]	2014	211	United States	1000

LDLT: Living donor liver transplantation.

Table 2 Recent articles focused on alpha-fetoprotein dynamic values

Ref.	Year	n	Country	Cut-off value(ng/mL per month)
Han et al[22]	2007	48	Canada	50
Vibert et al[23]	2010	153	France	15
Dumitra et al[24]	2013	92	Canada	0.11
Lai et al[25]	2013	422	Europe2	15

¹ng/mL per day;

²Austria, Belgium, Germany, Italy.

Table 3 Proposal for the integration of alpha-fetoprotein values and morphological tumor criteria into the selection process for liver transplantation in hepatocellular carcinoma cirrhotic patients

Criteria	No. of lesions	Maximum diameter (cm)	Last AFP value (ng/mL)	AFP slope (ng/mL per month)
MC	1	5	1000	15, 50, higher?
	2-3	3	1000	15, 50, higher?
UCSFC	1	5.1-6.5	1000?	50 or higher?
			1000 → 500? lower?
	2-3	3.1-4.5 (total sum 8)	1000?	50 or higher?
			1000 → 500? lower?
Out of conventional criteria			400? lower?	50 or higher?

AFP: Alpha-fetoprotein; MC: Milan Criteria; UCSFC: University of California San Francisco Criteria.