Milan Criteria for Liver Transplantation in HCC
- Tumor Size and Number:
- Single tumor: The largest tumor should be ≤ 5 cm in diameter.
- Multiple tumors: If there are multiple tumors, there should be no more than 3 tumors, and each tumor should be ≤ 3 cm in diameter.
- Absence of Extrahepatic Spread:
- There should be no evidence of tumor spread outside the liver (extrahepatic spread).
- Absence of Vascular Invasion:
- There should be no evidence of tumor invasion into the blood vessels (vascular invasion).
Patients meeting the Milan Criteria generally have a better prognosis after liver transplantation, with a post-transplant 5-year survival rate exceeding 70%. The criteria have become a standard for assessing transplant eligibility in many centers worldwide.
The Milan Criteria were originally proposed in 1996 by Dr. Vincenzo Mazzaferro and colleagues.
As a picture:

References
- Mazzaferro, V., Regalia, E., Doci, R., Andreola, S., Pulvirenti, A., Bozzetti, F., … & Gennari, L. (1996). Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. The New England Journal of Medicine, 334(11), 693-699.
- This is the original paper that introduced the Milan Criteria, providing the evidence base for using these criteria to select patients with HCC for liver transplantation.
- European Association for the Study of the Liver (EASL) Clinical Practice Guidelines: Management of Hepatocellular Carcinoma. Journal of Hepatology, 69(1), 182-236. (2018).
- This guideline outlines the management of hepatocellular carcinoma and includes a discussion of the Milan Criteria within the context of liver transplantation.
- Bruix, J., Sherman, M., & American Association for the Study of Liver Diseases. (2011). Management of hepatocellular carcinoma: an update. Hepatology, 53(3), 1020-1022.
- An update on the management of hepatocellular carcinoma, including the use of Milan Criteria in clinical decision-making for liver transplantation.