A 55-year-old man with end-stage liver disease from hepatitis C cirrhosis (MELD score 18, Child-Pugh B) and a single 4.8 cm hepatocellular carcinoma on a background cirrhosis is being assessed for liver transplantation. According to the Milan criteria, this patient is:

• A Within Milan criteria — single tumour ≤5 cm qualifies for transplantation
• B Within Milan criteria as the 4.8 cm tumour is within the single tumour ≤5 cm boundary and no satellite nodules exist ✓
• C Outside Milan criteria — single tumour ≤5 cm but Milan strictly requires no vascular invasion confirmed on explant
• D Outside Milan criteria — only tumours ≤3 cm qualify for transplantation under Milan

Explanation

The Milan criteria (Mazzaferro, 1996) for liver transplantation in HCC require: single tumour ≤5 cm OR up to 3 nodules each ≤3 cm, with no macrovascular invasion, and no extrahepatic disease. A single 4.8 cm HCC without vascular invasion or satellite nodules meets Milan criteria. These criteria are now used universally to select HCC patients for transplantation, achieving 4-year survival >75%. Extended criteria (UCSF criteria, up-to-7 rule) have been validated but Milan remains the international benchmark. The critical distinction is that Milan criteria are based on pre-transplant imaging; microscopic vascular invasion found on explant pathology affects prognosis but does not disqualify from transplant.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.