Review Article: Biomarkers in Liver Transplantation for Hepatocellular Carcinoma: Towards Precision Medicine

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related deaths worldwide. For eligible patients, liver transplantation is a curative treatment option, but recurrence after transplantation can severely affect long-term survival rates. Reliable biomarkers are urgently needed to optimise the entire transplantation process.

This review aims to summarize the role of traditional and emerging biomarkers in the treatment of HCC with liver transplantation, discuss the current challenges, and explore the direction of development in precision medicine.

We conducted a review of recent literature on protein biomarkers, genomic feature profiles, transcriptomic and proteomic markers, as well as the application of liquid biopsies in HCC liver transplantation.

Traditional biomarkers (including alpha-fetoprotein, its fucosylated variant AFP-L3, and protein induced by vitamin K absence or antagonism II) are widely used for recipient screening, staging, and recurrence prediction. Emerging multi-omics markers and liquid biopsy markers provide deeper molecular insights and enable non-invasive real-time monitoring. They assist in pre-transplant risk stratification, downstaging response assessment, early recurrence detection, and guidance of personalised immunosuppression and adjuvant therapy.

Biomarkers are the core tools for precision medicine in liver transplantation for HCC. Despite challenges in standardization and clinical application, combining traditional biomarkers with multi-omics and liquid biopsy technologies holds promise for further improving patient prognosis.