Liver transplantation and expanded Milan criteria: does it really work?

Abstract

-Context -Orthotopic liver transplantation is an excellent treatment approach for hepatocellular carcinoma in well-selected candidates. Nowadays some institutions tend to Expand the Milan Criteria including tumor with more than 5 cm and also associate with multiple tumors none larger than 3 cm in order to benefit more patients with the orthotopic liver transplantation. Methods -The data collected were based on the online database PubMED. The key words applied on the search were "expanded Milan criteria" limited to the period from 2000 to 2009. We excluded 19 papers due to: irrelevance of the subject, lack of information and incompatibility of the language (English only). We compiled patient survival and tumor recurrence free rate from 1 to 5-years in patients with hepatocellular carcinoma submitted to orthotopic liver transplantation according to expanded the Milan criteria from different centers. Results -Review compiled data from 23 articles. Fourteen different criteria were found and they are also described in detail, however the University of California -San Francisco was the most studied one among them. Conclusion -Expanded the Milan criteria is a useful attempt for widening the preexistent protocol for patients with hepatocellular carcinoma in waiting-list for orthotopic liver transplantation. However there is no significant difference in patient survival rate and tumor recurrence free rate from those patients that followed the Milan criteria.

Hangzhou criteria for liver transplantation in hepatocellular carcinoma

“…In previous reports, most of the inclusion criteria for LT in HCC calculated the tumor burden only on the basis of the tumor number and diameter; although some studies included the total tumor volume [28][29][30], only the Hangzhou criteria include other biological characteristics such as AFP level and histological grading [8]. Therefore, the Hangzhou criteria may be useful for patients, especially in China, where HCC is typically more advanced at diagnosis.…”

“…The Milan criteria for LT in HCC were first proposed in 1996 by Mazzaferro et al [7] and stated that for solitary HCC with a diameter of 5 cm or less or up to three nodules smaller than 3 cm, LT will result in better survival (5-year survival of 61.1% vs. 5-year survival of 25.3% previously observed in 1987). However, with the development of transplantation technology and accumulated experience, some groups have argued that the Milan criteria are too restrictive and thus exclude some HCC patients from LT despite the possibility of a survival benefit [8]. In the past 10 years, numerous studies have evaluated new criteria for LT that increase the limits on the number and size of HCC lesions without compromising the survival rate [9].…”

Advances in predicting the prognosis of hepatocellular carcinoma recipients after liver transplantation

“…Milan criteria are the most widely used criteria for patient selection (a single tumor up to 5 cm or up to 3 tumors with none larger than 3.0 cm, no major vascular invasion, no lymph node or extrahepatic metastasis). Long-term follow-up after LT in HCC patients with Milan criteria was found to have an ideal prognosis, and the 5-year survival rate was increased to 61.1% or even up to 70% (Ferreira et al, 2012). In 1998, the United Network Organ Sharing (UNOS) also uses Milan criteria as the main selection criteria.…”