ArticleClinical transplantation and research2026
Prognostic validation of ADV and MoRAL scores for hepatocellular carcinoma recurrence following living donor liver transplantation: a long-term follow-up study.
Article in Clinical transplantation and research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: This study compared the prognostic performance of the ADV (α-fetoprotein × des-γ-carboxyprothrombin × tumor volume) and MoRAL (Model to Predict Tumor Recurrence After Liver Transplantation) scores in predicting hepatocellular carcinoma (HCC) tumor recurrence (TR) and overall survival (OS) after living donor liver transplantation (LDLT). Methods: We analyzed 843 patients with HCC who underwent LDLT between 2006 and 2015, assessing TR and OS in relation to the ADV and MoRAL scores. Results: The median ADV and MoRAL scores were 3.7 log and 70.6, respectively, with a moderate correlation between them (r=0.569, P<0.001). The 5-year time-dependent area under the receiver operating characteristic curve for the ADV score in predicting posttransplant TR was significantly higher than that for the MoRAL score (0.750 vs. 0.671, P<0.001). Using cutoff values of 5.0 log for the ADV score and 314.8 for the MoRAL score, as well as combined thresholds of 4.0 log and 7.0 log and 114.4 and 314.8, respectively, both scores provided clear two- and three-tier stratifications for TR and OS (all P<0.001). The ADV score demonstrated higher hazard ratios for both TR and OS compared with the MoRAL score. Conclusions: Both the ADV and MoRAL scores function as composite surrogate biomarkers for posttransplant prognosis in HCC patients undergoing LDLT; however, the ADV score offers a more precise and reliable prognostic assessment. Furthermore, applying revised cutoff values to the MoRAL score may increase its predictive accuracy and clinical utility.
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