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Purpose <p>Serum gamma-glutamyl transferase (GGT) has been implicated as a biomarker of tumor aggressiveness across various malignancies. This study aimed to assess the utility of pre-transplant GGT in predicting post-transplant recurrence in living donor liver transplantation (LDLT) for hepatocellular carcinoma (HCC).</p> Methods <p>In this single-center retrospective cohort study, 331 patients undergoing LDLT for HCC under expanded criteria were analyzed. Descriptive statistics and Kaplan-Meier curves were used to determine association between GGT levels and recurrence free survival (RFS).</p> Results <p>With a median follow-up of 49 months (IQR: 21–85), HCC recurred in 63 patients (19%). In multivariate analysis, GGT &gt; 100 U/L was independently associated with increased recurrence risk (HR: 2.7; 95% CI: 1.6–4.5; <i>P</i> &lt; 0.001). Elevated pre-transplant GGT (&gt; 100 U/L) was associated with adverse tumor features, including tumor size (&gt; 5&#xa0;cm) and elevated alpha-fetoprotein (AFP) levels (both <i>P</i> &lt; 0.05). MVI was more frequently observed in the high GGT group (41.0% vs. 22.2%, <i>P</i> &lt; 0.001). The 5-year RFS was significantly lower in patients with high GGT (64% vs. 88%, <i>P</i> &lt; 0.001). For patients in the expanded criteria, with GGT ≤ 100 U/L, 5-year RFS was not significantly different from Milan criteria (5-year RFS: 82% vs. 85%, <i>P</i> = 0.243). In patients with normal AFP, GGT ≤ 100 U/L identified a favorable subgroup with a 5-year RFS of 95%.</p> Conclusion <p>Elevated pre-transplant GGT is independently associated with post-transplant recurrence in HCC patients undergoing LDLT. Integration of GGT into expanded selection criteria may improve biological risk stratification beyond conventional imaging- and AFP-based models.</p>

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Gamma-Glutamyl Transferase Improves Biological Risk Stratification in Living Donor Liver Transplantation for Hepatocellular Carcinoma

  • 期刊论文

  • 发表日期：

    2026年2月8日

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  • Abu Bakar Hafeez Bhatti,
  • Muhammad Usman Shafique,
  • Muhammad Nauman Ul Haq,
  • Hajira Ghairat,
  • Jamshaid Anwar,
  • Zafar Ali

摘要

Purpose

Serum gamma-glutamyl transferase (GGT) has been implicated as a biomarker of tumor aggressiveness across various malignancies. This study aimed to assess the utility of pre-transplant GGT in predicting post-transplant recurrence in living donor liver transplantation (LDLT) for hepatocellular carcinoma (HCC).

Methods

In this single-center retrospective cohort study, 331 patients undergoing LDLT for HCC under expanded criteria were analyzed. Descriptive statistics and Kaplan-Meier curves were used to determine association between GGT levels and recurrence free survival (RFS).

Results

With a median follow-up of 49 months (IQR: 21–85), HCC recurred in 63 patients (19%). In multivariate analysis, GGT > 100 U/L was independently associated with increased recurrence risk (HR: 2.7; 95% CI: 1.6–4.5; P < 0.001). Elevated pre-transplant GGT (> 100 U/L) was associated with adverse tumor features, including tumor size (> 5 cm) and elevated alpha-fetoprotein (AFP) levels (both P < 0.05). MVI was more frequently observed in the high GGT group (41.0% vs. 22.2%, P < 0.001). The 5-year RFS was significantly lower in patients with high GGT (64% vs. 88%, P < 0.001). For patients in the expanded criteria, with GGT ≤ 100 U/L, 5-year RFS was not significantly different from Milan criteria (5-year RFS: 82% vs. 85%, P = 0.243). In patients with normal AFP, GGT ≤ 100 U/L identified a favorable subgroup with a 5-year RFS of 95%.

Conclusion

Elevated pre-transplant GGT is independently associated with post-transplant recurrence in HCC patients undergoing LDLT. Integration of GGT into expanded selection criteria may improve biological risk stratification beyond conventional imaging- and AFP-based models.