Liver transplantation for small hepatocellular carcinomas in patients with cirrhosis (the Milan criteria)
This study showed that liver transplantation cures most patients with cirrhosis whose liver cancer is limited to one tumour up to 5 cm or up to three tumours each up to 3 cm, the Milan criteria that have governed transplant selection ever since.
Overview
Prospective cohort of 48 patients with cirrhosis and unresectable hepatocellular carcinoma meeting size criteria (single tumour 5 cm or less, or up to three tumours each 3 cm or less) who underwent liver transplantation.
Four-year overall survival was 75 percent and recurrence-free survival 83 percent, with 85 percent overall survival among the 35 patients whose explants confirmed the criteria, compared with poor historical results in unselected patients.
- Four-year overall survival 75 percent; recurrence-free survival 83 percent.
- 85 percent four-year survival when explant pathology confirmed the criteria.
The Milan criteria remain the global standard for transplant eligibility in hepatocellular carcinoma, with downstaging protocols extending access to patients just outside them.
- Small single-centre series; expanded criteria (UCSF, up-to-seven) have since been proposed.