The Milan criteria for liver transplantation in hepatocellular carcinoma (HCC) define the boundaries for acceptable HCC burden. A patient with cirrhosis has a single HCC nodule of 4.8 cm with no vascular invasion and no extrahepatic disease. Does this patient meet the Milan criteria?

• A No — the Milan criteria require a single nodule ≤3 cm
• B Yes — any single HCC without metastases qualifies
• C No — only multinodular disease qualifies for transplantation
• D Yes — single nodule ≤5 cm without vascular invasion ✓

Explanation

The Milan criteria (Mazzaferro, 1996) for liver transplantation in HCC are: a single tumor ≤5 cm in diameter, OR up to three nodules each ≤3 cm, with no macrovascular invasion and no extrahepatic metastases. A single 4.8 cm tumor without vascular invasion meets these criteria. Patients within Milan criteria achieve post-transplant 5-year survival rates of approximately 70% with a recurrence rate <15%, comparable to transplantation for non-malignant disease.

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

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