In liver transplantation for hepatocellular carcinoma, the Milan criteria define acceptable limits for transplant candidacy. Which correctly states the Milan criteria?
- A Single nodule ≤5 cm, or up to 3 nodules each ≤3 cm, no macrovascular invasion, no extrahepatic disease ✓
- B Single nodule ≤6 cm, or up to 4 nodules each ≤4 cm, no extrahepatic disease
- C Single nodule ≤5 cm or up to 5 nodules each ≤3 cm (UCSF criteria)
- D Total tumour diameter ≤8 cm regardless of number of nodules, no macrovascular invasion
Explanation
The Milan criteria (Mazzaferro et al., NEJM 1996) define acceptable HCC for liver transplantation as: a single nodule ≤5 cm, or up to 3 nodules each ≤3 cm, with no macrovascular invasion and no extrahepatic metastases. Within Milan, 5-year survival post-transplant is approximately 75% with recurrence <10%. UCSF expanded criteria (option C) allow a single tumour ≤6.5 cm or ≤3 tumours with the largest ≤4.5 cm and total diameter ≤8 cm — with comparable outcomes in selected centres. Downstaging to within Milan criteria using TACE/ablation followed by transplant is now guideline-accepted.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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