The Milan criteria are used to select patients with hepatocellular carcinoma for liver transplantation. A patient has a single HCC nodule of 6.5 cm and no vascular invasion on imaging. He has liver cirrhosis (Child-Pugh B). Which statement is accurate regarding transplant eligibility and the UCSF criteria?

• A UCSF criteria allow a single HCC up to 8 cm; this patient satisfies UCSF criteria
• B Milan criteria allow a single HCC up to 5 cm or up to 3 nodules each ≤3 cm; this patient exceeds Milan but satisfies UCSF criteria ✓
• C Milan and UCSF criteria are equivalent; both allow up to 5 cm for a single lesion
• D The patient satisfies Milan criteria as 6.5 cm is within the 7 cm threshold

Explanation

Milan criteria (Mazzaferro 1996): single HCC ≤5 cm OR up to 3 nodules each ≤3 cm, no vascular invasion, no extrahepatic disease. UCSF criteria (Yao 2001): single HCC ≤6.5 cm OR up to 3 nodules with largest ≤4.5 cm and total tumour diameter ≤8 cm, no vascular invasion. This patient's single 6.5 cm nodule exceeds Milan criteria (threshold 5 cm) but exactly meets the UCSF threshold (≤6.5 cm). Both criteria require no vascular invasion. Multiple studies have validated UCSF criteria with 5-year post-transplant survival comparable to Milan; UCSF criteria are accepted by many centres to expand the donor pool. Down-staging protocols are also used to convert patients exceeding criteria.

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

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