Milan criteria in liver transplantation for hepatocellular carcinoma: An evidence-based analysis of 15 years of experience

Mazzaferro, Vincenzo; Bhoori, Sherrie; Sposito, Carlo; Bongini, Marco; Langer, Martin; Miceli, Rosalba; Mariani, Luigi

doi:10.1002/lt.22365

Cited by 501 publications

(350 citation statements)

References 114 publications

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“…Patients with low hepatic reserve who cannot tolerate hepatectomy may undergo orthotopic liver transplantation under certain circumstances. Selection for transplant is based upon tumor criteria such as the Milan criteria, which includes patients who have a solitary tumor <5 cm, or 3 lesions <3 cm and localized disease without vascular invasion [42]. Other treatments for disease that remains within the liver include radiofrequency ablation or transarterial chemoembolization, often used alone or as a bridge to transplant.…”

Section: Differences In Presentation Treatment and Survival Among Afmentioning

confidence: 99%

Worse Outcomes among African Americans with Liver Cancer: What Might Cause the Disparity?

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2017

Austin J Gastroenterol

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Liver cancer remains an important cause of cancer mortality in the United States. Incidence of hepatocellular carcinoma (HCC), the most common histological cell type of liver cancer, has increased over the past 30 years. The statistics are particularly worrisome for African Americans. Their incidence of HCC far surpasses that of other races, particularly whites. Additionally, mortality for African Americans with HCC is also far worse. In a review of the literature, we found a stepwise progression of variables that may contribute to this observation. African Americans have the highest observed rates of infection with chronic hepatitis and are offered treatment less often for hepatitis C virus. The progression to cirrhosis is slower, which may complicate HCC surveillance. Regardless, they receive surveillance either biochemical or radiographic at a lower rate than patients of other races. Further, African Americans present at a more advanced stage and are referred for curative therapy less often. When African Americans do receive therapy, their outcomes are worse. Additional investigation is warranted as to whether differences in tumor biology may also play a role.

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Section: Differences In Presentation Treatment and Survival Among Afmentioning

confidence: 99%

Worse Outcomes among African Americans with Liver Cancer: What Might Cause the Disparity?

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2017

Austin J Gastroenterol

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“…In a systematic review of such studies, Mazzaferro et al in 2011 looked at 90 studies spanning a period of 15 years and including 17,780 patients. 6 Only 17% of the studies, including 1612 patients had level 1b evidence. In 9 studies, patients who met Milan criteria and underwent liver transplant had post-transplant survival rates comparable to patients transplanted for non-tumor indications.…”

Section: The Milan Criteriamentioning

confidence: 99%

Role of Liver Transplantation for Hepatocellular Carcinoma

Kumaran

2014

Journal of Clinical and Experimental Hepatology

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“…The introduction and evolution of LDLT also challenged paradigms of utility because the living donor graft is a private gift. A recent meta-analysis revealed that the Milan criteria were significantly predictive of better biological characteristics (lower microvascular invasion rate, lower proportion of poorly differentiated histology, lower AFP levels, lower incidence of microsatellites) [30]. The analysis favored LT for patients within Milan criteria than those outside it.…”

Section: Rationale For Extended Criteriamentioning

confidence: 99%

“…While several studies have attempted to push the envelope while enrolling patients with HCC for LT particularly using LDLT, most of them are retrospective and based on explant data, which are not available at time of inclusion and very few have been prospectively and externally validated [30]. The fundamental questions to be answered are what constitutes an acceptable outcome and how much does extension of criteria impact the non-HCC waiting list.…”

Section: How Far Is Too Far?mentioning

confidence: 99%

Liver Transplantation for HCC: A Review

Kakodkar¹,

Soin²

2011

Indian J Surg

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Hepatocellular carcinoma (HCC) often occurs in patients with chronic liver disease or cirrhosis. Liver transplantation for hepatocellular carcinoma has the potential to eliminate both the tumor as well as the underlying cirrhosis and is the ideal treatment for HCC in cirrhotic liver as well as massive HCC in noncirrhotic liver. Limitations in organ availability, necessitate stringent selection of patients who would likely to derive most benefit. Selection criteria have considered tumor size, number, volume as well as biological features. The Milan criteria set the benchmark for tumors that would benefit from liver transplantation but were found to be excessively restrictive. Modest expansion in criteria has also been shown to be associated with equivalent survival. Microvascular invasion is the single most important adverse prognostic factor for survival. Living donor liver transplantation has expanded donor options and has the advantage of lower waiting period and not impacting the non-HCC waiting list. Acceptable outcomes have been obtained with living donor liver transplantation for larger and more numerous tumors in the absence of microvascular invasion. Downstaging of tumors to prevent progression while waiting for an organ or for reduction in size to allow enrolment for transplantation has met with variable success.

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Milan criteria in liver transplantation for hepatocellular carcinoma: An evidence-based analysis of 15 years of experience

Cited by 501 publications

References 114 publications

Worse Outcomes among African Americans with Liver Cancer: What Might Cause the Disparity?

Worse Outcomes among African Americans with Liver Cancer: What Might Cause the Disparity?

Role of Liver Transplantation for Hepatocellular Carcinoma

Liver Transplantation for HCC: A Review

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