Elsevier

Journal of Hepatology

Volume 55, Issue 5, November 2011, Pages 1137-1147
Journal of Hepatology

Frontiers in Liver Transplantation
Criteria for liver transplantation for HCC: What should the limits be?

https://doi.org/10.1016/j.jhep.2011.05.012Get rights and content
Under a Creative Commons license
open access

Summary

Liver transplantation is a well-established treatment in a subset of patients with cirrhosis and hepatocellular carcinoma. The Milan criteria (single nodule up to 5 cm, up to three nodules none larger than 3 cm, with no evidence of extrahepatic spread or macrovascular invasion) have been traditionally accepted as standard of care. However, some groups have proposed that these criteria are too restrictive, and exclude some patients from transplantation who might benefit from this procedure. Transplanting patients with tumors beyond the established criteria falls into two categories, those whose tumors are beyond the Milan criteria at presentation without the use of treatment prior to transplantation (expanded criteria), and those in whom treatment allows the Milan Criteria to be fulfilled (down-staging). Currently, however, there is no international consensus regarding these approaches in clinical practice. The purpose of this systematic review is to clarify this debate through a critical analysis of available data. Finally, some comments on predictive factors apart from morphological characteristics are also addressed.

Abbreviations

HCC
hepatocellular carcinoma
LT
liver transplantation
UNOS
United Network for Organ Sharing
MC
Milan criteria
EASL
European Association for the Study of the Liver
AASLD
American Association for the Study of Liver Diseases
EC
expanded criteria
UCSF
University of California, San Francisco
WL
waiting list
ITT
intention-to-treat
DS
down-staging
AFP
alpha-fetoprotein
TACE
trans-arterial chemoembolization
RECIST
Response Evaluation Criteria in Solid Tumors
DCP
des-gamma-carboxy-prothrombin

Keywords

Hepatocellular carcinoma
Liver transplantation
Expanded criteria
Down-staging
Milan criteria
Systematic review
Evidence based medicine

Cited by (0)