The use of alpha-fetoprotein measurement in detection of recurrent hepatocellular carcinoma after living donor liver transplantation N. Yamashiki 1,2 , Y. Sugawara 1,3 , S. Tamura 3 , R. Tateishi 2 , H. Yoshida 2 , J. Kaneko 3 , Y. Matsui 3 , N. Kokudo 1,3 , M. Omata 2 1 Organ Transplantation Service, 2 Department of Gastroenterology, University of Tokyo, 3 Department of Surgery, University of Tokyo Background: The recurrent hepatocellular carcinoma (rHCC) after liver transplantation (LT) can occur in 10 to 20 % of transplant recipients despite with a careful patient selection. For the surveillance of rHCC, frequent measurement of alpha-fetoprotein (AFP) and annual CT scan is commonly used. However, the usefulness of AFP is not clear. We report the update of our experience using our surveillance protocol. Methods: Between 1996 and March 2008, 330 adult living donor LT were performed at the University of Tokyo. Among them, 100 recipients with HCC in their explanted liver were subjected to analysis. We used monthly measurement of AFP and des-gamma carboxy prothrombin (DCP) with annual dynamic CT scan. Results: 83 met Milan criteria pre-operatively and 12 did not. 5 were incidental HCC. rHCC was experienced in 9 patients at 10 (2-24) months after LT. Recurrence sites were graft (1), lung (2), bone (3), and multiple organs (3). rHCC was first suspected from elevation of tumor markers in 8; AFP in 4, DCP in 2, and both AFP and DCP in 2. rHCC was confirmed with CT scan (7) or MRI (2) in 4 (0-6) months after the first sign of rHCC. When the cutoff level of AFP>20ng/ml was used, the sensitivity and specificity for rHCC were 66% and 100%. Six cases were treated surgically of which two achieving prolonged survival. Conclusions: Although the confirmation of the rHCC sites required multiple imaging studies, AFP measurement was useful as for the first sign of rHCC.