A 50-year-old patient with end-stage liver disease from NASH cirrhosis (MELD score 22) is being evaluated for liver transplantation. He is found to have 3 hepatocellular carcinoma (HCC) nodules: 2 cm, 2.5 cm, and 3.8 cm on CT. According to the Milan criteria for liver transplantation, he is:
- A Within Milan criteria — eligible for listing
- B Beyond all criteria — transplantation is contraindicated
- C Within Milan criteria only if alpha-fetoprotein is <200 ng/mL
- D Outside Milan criteria — UCSF criteria may still make him eligible ✓
Explanation
Milan criteria for liver transplantation for HCC: single tumor ≤5 cm OR up to 3 nodules with none >3 cm, no vascular invasion, no extrahepatic spread. This patient has 3 nodules but one is 3.8 cm (>3 cm), placing him outside Milan criteria. However, UCSF (University of California San Francisco) extended criteria allow: single tumor ≤6.5 cm OR up to 3 tumors with the largest ≤4.5 cm and total tumor diameter ≤8 cm. His largest tumor is 3.8 cm and total = 8.3 cm — he is marginally outside UCSF too. However, downstaging protocols (TACE, ablation) to bring tumors within criteria before listing are accepted by UNOS. Alpha-fetoprotein threshold (>1000 ng/mL predicts worse outcomes) has been incorporated into UCSF policies.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.