The Milan criteria for liver transplantation in hepatocellular carcinoma define acceptable tumor burden. Following the UCSF extension criteria, which patients with HCC are eligible for transplantation beyond Milan criteria?

• A Single tumor ≤6.5 cm, or up to 3 tumors with none >4.5 cm and total diameter ≤8 cm ✓
• B Any number of tumors up to 8 cm total diameter, no vascular invasion
• C Single tumor ≤5 cm or up to 3 tumors ≤3 cm each (Milan criteria)
• D Tumors responding to TACE regardless of initial size

Explanation

The UCSF criteria (Yao et al., 2001) expanded Milan criteria to include: single tumor ≤6.5 cm in diameter OR up to 3 tumors with the largest ≤4.5 cm and total tumor diameter ≤8 cm, with no vascular invasion or extrahepatic spread. UCSF criteria were validated in explant pathology and showed 5-year survival rates comparable to Milan criteria. Option C describes Milan criteria (single ≤5 cm or ≤3 tumors each ≤3 cm). Down-staging protocols (including post-TACE response) have now also been incorporated into US transplant allocation policy but require documentation of response, not just any TACE.

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

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Written and medically reviewed by the StethoPrep medical team.