Selection criteria in liver transplantation for HCC*
| Criteria | Definition | Features |
|---|---|---|
| Milan (MC) | Single lesion ≤5 cm Up to 3 lesions ≤3 cm No macrovascular invasion | The benchmark of patient selection criteria in patients undergoing LT for HCC endorsed in major international guidelines |
| UCSF | Single ≤6.5 cm Up to three lesions ≤4.5 cm Sum of tumour diameter ≤8 cm | Significant overlap with MC allowing at best the expansion of LT candidate with HCC of around 5% |
| Up-to-7 | Sum of size (cm) and number of HCC nodules ≤7 No mVI | Flexible approach allowing patients with different size-and-number combinations to compete for the same survival. Online calculator at http://hcc-olt-metroticket.org/calculator |
| TTV+AFP | Any lesions up to TTV ≤115 cm3 AFP ≤400 ng/mL | Combined score would exclude large HCC or small one with potentially aggressive behaviour and poor post-LT outcomes |
| Milan+AFP | Score system based Number of nodules Size of the largest nodule AFP at listing (<100; 100–1000; >1000 ng/mL) | Within MC, score ≤2 predicts good survival. Patients exceeding MC with AFP <100; ≤3 nodules; ≤6 cm might be considered eligible for LT |
*Only criteria with population/registry-based collection or meta-analysis of the current evidence are listed.
AFP, α-fetoprotein; HCC, hepatocellular carcinoma; LT, liver transplantation; MC, Milan Criteria; mVI, microvascular invasion; TTV, total tumour volume; UCSF, University of California San Francisco.