{
  "abstract": "Background/Objectives: Tumor size and number do not fully capture the risk of hepatocellular carcinoma (HCC) recurrence after liver transplantation. We examined whether the pretransplant tumor-to-liver maximum standardized uptake value (SUV) ratio on 18F-FDG PET/CT is associated with recurrence, and assessed the previously reported cutoff of 1.43 in an independent cohort. Methods: We retrospectively analyzed 227 adults who underwent liver transplantation for HCC between July 2004 and November 2024 and had pretransplant FDG PET/CT. The primary endpoint was time to recurrence (TTR). The SUV ratio was analyzed as a continuous, log2-transformed variable in Cox models adjusted for age, MELD-Na, alpha-fetoprotein (AFP), and Milan status; the 1.43 cutoff was a secondary analysis. Death without recurrence was treated as a competing event. Results: Over a median follow-up of 80 months, 43 patients developed recurrence and 86 died. Each doubling of the SUV ratio was associated with a higher recurrence rate (adjusted HR 6.68; 95% CI 3.58–12.47) and higher mortality (HR 2.79; 95% CI 1.72–4.53). The 5-year cumulative incidence of recurrence was 44.7% with a ratio >1.43 and 7.5% with a ratio ≤1.43. Only 2 of 51 non-FDG-avid tumors recurred. The ratio added prognostic information to Milan criteria and AFP (likelihood ratio χ2 28.5; p < 0.001) and stratified risk within the Milan criteria (5-year cumulative incidence of recurrence, 26.4% vs. 5.2%). Conclusions: A high pretransplant tumor-to-liver SUV ratio was strongly associated with recurrence independently of Milan status and AFP. External validation with standardized PET protocols is needed before clinical use.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Surgery, Bahçelievler Medipol University Hospital, Istanbul Medipol University, Istanbul 34197, Türkiye",
    "Department of Surgery, Faculty of Medicine, Hacettepe University, Ankara 06100, Türkiye",
    "Department of Liver Transplantation, Istanbul Florence Nightingale Hospital, Istanbul 34381, Türkiye"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 3,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Ahmet Atasever",
      "orcid": "0000-0002-7495-4160"
    },
    {
      "affs": [
        1
      ],
      "name": "Sinan Efe Yazici",
      "orcid": "0009-0001-1803-0633"
    },
    {
      "affs": [
        2
      ],
      "name": "Yildiray Yuzer"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/86jjgw743xb1b.bib",
  "cited_by": 0,
  "doi": "10.3390/jcm15218611",
  "fulltext_url": null,
  "id": "86jjgw743xb1b",
  "issns": [
    "2077-0383"
  ],
  "landing_url": "https://www.mdpi.com/2077-0383/15/21/8611",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [],
  "openalex": null,
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-11-05",
  "publisher": "MDPI AG",
  "ris": "https://research.draconitic.com/paper/86jjgw743xb1b.ris",
  "sources": [
    {
      "first_seen": "2026-11-05T12:21:24Z",
      "native_id": "10.3390/jcm15218611",
      "source": "crossref",
      "url": "https://www.mdpi.com/2077-0383/15/21/8611"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "journal-openalex:F27",
      "subfield": "general"
    }
  ],
  "title": "Beyond Morphology: Pretransplant Tumor-to-Liver FDG Uptake Ratio Predicts Hepatocellular Carcinoma Recurrence After Liver Transplantation",
  "title_text": "Beyond Morphology: Pretransplant Tumor-to-Liver FDG Uptake Ratio Predicts Hepatocellular Carcinoma Recurrence After Liver Transplantation",
  "type": "peer-reviewed",
  "updated_at": "2026-11-07T00:21:23Z",
  "url": "https://research.draconitic.com/paper/86jjgw743xb1b",
  "venue": "Journal of Clinical Medicine",
  "versions": []
}