A 48-year-old man with end-stage liver disease due to hepatocellular carcinoma (HCC) is being evaluated for liver transplantation. His HCC has 2 lesions: one 3.5 cm and one 2 cm, with no macrovascular invasion or extrahepatic disease. What transplant criteria does he meet?

• A UCSF criteria — qualifies but not Milan
• B Neither Milan nor UCSF — exceeds both criteria
• C Milan criteria — qualifies for transplantation ✓
• D Milan criteria only if AFP < 400 ng/mL

Explanation

Milan criteria for liver transplantation in HCC: single lesion ≤5 cm, OR up to 3 nodules each ≤3 cm, no macrovascular invasion, no extrahepatic disease. This patient has 2 lesions (3.5 cm + 2 cm), both ≤3 cm, with no vascular invasion — satisfying Milan criteria. UCSF criteria are more expanded (single ≤6.5 cm OR 3 nodules with largest ≤4.5 cm, total tumor diameter ≤8 cm). Meeting Milan criteria is associated with 5-year survival >70%, equivalent to transplantation for benign disease, justifying its use as the international standard.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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