A patient with end-stage liver disease due to hepatocellular carcinoma (HCC) is evaluated for liver transplantation. His single HCC tumor measures 4.5 cm with no vascular invasion, no satellite nodules, and AFP is 200 ng/mL. Does he meet the Milan criteria for transplantation?

• A Yes; Milan criteria allow a single tumor up to 5 cm
• B No; Milan criteria restrict single tumor to ≤5 cm, but the AFP level of 200 ng/mL excludes him
• C No; Milan criteria only allow tumors ≤3 cm
• D Yes; a single tumor of 4.5 cm with no vascular invasion meets Milan criteria (single tumor ≤5 cm OR up to 3 tumors all ≤3 cm) ✓

Explanation

The Milan criteria for liver transplantation in HCC are: a single tumor ≤5 cm, OR up to 3 tumors with none exceeding 3 cm, with no macrovascular invasion and no extrahepatic metastases. This patient has a single 4.5 cm tumor with no vascular invasion, which satisfies the Milan criteria (single tumor ≤5 cm). AFP alone (at 200 ng/mL) does not disqualify a patient from Milan criteria, though very high AFP (>1000 ng/mL) has prognostic significance. Liver transplantation within Milan criteria achieves 4-year recurrence-free survival of approximately 83%.

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

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Written and medically reviewed by the StethoPrep medical team.