Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: a retrospective, exploratory analysis

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

“…Presumably, this sample size represented All-or-none case series B 0/0 -2a [24][25][26] Systematic review with homogeneity of either retrospective cohort studies or untreated control groups in RCTs B 3/8201 7 (6-8) 2b Retrospective cohort study or follow-up of untreated control patients in an RCT or derivation of clinical decision rules validated in a split sample only B 62/7842 6 (4-8) 2c…”

“…The meta-analysis included 19 studies 2,15,16,19,26,33,35,39,40,42,46,48,[53][54][55]57,63,67,84 that used different methodologies to compare the overall survival of patients meeting the MC and patients exceeding the criteria at the time of the explant pathology examination; 3949 patients were also stratified by the graft origin (deceased or living donors).…”

Toward optimizing the indications for orthotopic liver transplantation in hepatocellular carcinoma

“…However, this policy implies that some patients with HCC slightly more advanced than those allowed by the current strict selection criteria will be excluded, even though liver transplantation for these patients might be associated with acceptable (if not excellent) long-term outcomes. 24,25 The main findings of a 2005 French consensus conference on indications for liver transplantation were as follows: 26 HCC, a pathological examination of the explanted liver reveals no HCC. In the United States, this lack of evidence in explanted livers occurs for 14% of patients with a diagnosis of HCC before liver transplantation.…”

“…34,35 Several groups have proposed extensions of the Milan criteria for liver transplantation, but most studies that are cited in support of these proposals have been retrospective and have been based on analyses of explanted livers (ie, information not available before surgery). 24,[35][36][37][38][39] Recently, Mazzaferro et al 25 made an interesting contribution to this controversy in their retrospective review of pathology after liver transplantation for HCC in 1556 patients; 1112 of these patients had tumors that did not fulfill the Milan criteria. In a subgroup of 283 patients not meeting the Milan criteria whose tumors were within the up-to-7 criteria (ie, HCCs with a maximum score of 7, with the score being the sum of the size of the largest tumor and the total number of tumors) and were not characterized by microvascular invasion, the overall 5-year survival rate was 71.2%.…”

Should we perform deceased donor liver transplantation after living donor liver transplantation has failed?

“…Commonly, these criteria include stage T2-N0-M0 tumors that fulfill the Milan criteria for size and number 30 (often without radiological evidence of venous tumor thrombi). Because in most jurisdictions this increased priority is essential for HCC patients, those who do not fulfill these criteria either are not listed or, if they are listed, are unlikely to ever be offered DDLT because they are not eligible for priority unless they are prepared to accept a high-risk organ that has been rejected for all others on the list.…”