Milan Criteria for HCC

  Hepatology, Liver transplantation

Milan Criteria for Liver Transplantation in HCC

  1. 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.
  2. Absence of Extrahepatic Spread:
    • There should be no evidence of tumor spread outside the liver (extrahepatic spread).
  3. 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

  1. 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.
  1. 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.
  1. 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.