In liver transplantation, the Milan criteria are used to select patients with hepatocellular carcinoma (HCC). What are the Milan criteria?

• A Single HCC ≤7 cm with no vascular invasion or extrahepatic disease
• B Up to 5 nodules each ≤4 cm with total tumour volume <28 cm³
• C Single HCC ≤3 cm with AFP <200 ng/mL and no satellite nodules
• D Single HCC ≤5 cm OR up to 3 nodules each ≤3 cm, no macrovascular invasion, no extrahepatic spread ✓

Explanation

The Milan criteria for liver transplantation in HCC are: a single tumour ≤5 cm, or up to 3 tumours each ≤3 cm, with no macrovascular invasion and no extrahepatic disease. Patients meeting Milan criteria achieve 5-year post-transplant survival comparable to patients transplanted for non-HCC indications (~70%). Extended criteria (UCSF criteria: single ≤6.5 cm or ≤3 nodules with largest ≤4.5 cm and total diameter ≤8 cm) have been proposed. AFP level is not part of the original Milan criteria though it is now incorporated in allocation scoring.

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

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