Carbohydrate 19-9 antigen as a marker of non-malignant hepatocytic ductular transformation in patients with acute liver failure - A comparison with alpha-fetoprotein and carcinoembryonic antigen

Background: We have observed increased serum tumor markers. especially carb ohydrate antigen 19-9 (CA 19-9) levels, in patients with acute liver failur e (ALF) being evaluated fur liver transplantation, raising the question of potential malignancy. In chronic liver disease increased serum alpha-fetopr otein (AFP) may be a sign of liver regeneration. but little is known of the se markers in ALF. The aim of this study was to evaluate the causes of over expression of tumor markers in patients with non-malignant ELF. Methods: Th e serum AFP, carcinoembryonic antigen (CEA), and CA 19-9 levels were compar ed with the liver function tests in 33 patients with acute liver failure an d in 78 patients with chronic non-malignant liver disease being evaluated f or liver transplantation. Immunohistochemical stainings of the: tumor marke rs were performed on explanted liver specimens. Results: The AFP (1-218 U/m l) and CA 19-9 (10-6520 U/ml) levels were significantly higher in the patie nts with ALF than in the patients with chronic liver disease (P < 0.01). Th e AFP and CA 19-9 values also correlated with the total serum bilirubin lev el. In the patients with ALF the immunohistochemical staining for CA 19-9 w as highly positive in periportal transformed ductular hepatocytes and corre lated positively with the serum CA 19-9 values (P < 0.001). The stainings f or AFP or CEA showed no or only slight positivity in the patients with incr eased serum values of the tumor markers. Conclusions: In patients with ALF increased serum levels of CA 19-9 reflect the amount of transformed ductula r hepatocytes without any evidence of malignancy. Increased CA 19-9 values should not be the cause of delay when an ALF patient needs an urgent liver rr;transplantation.