A 48-year-old patient with hepatocellular carcinoma (HCC) is being assessed for liver transplantation. CT shows a single 5.5 cm HCC with no vascular invasion and no extrahepatic spread. Is this patient within Milan criteria for transplant?
- A Yes — single tumour <5 cm qualifies
- B No — single tumour must be ≤5 cm; 5.5 cm exceeds Milan criteria ✓
- C Yes — single tumour ≤6 cm qualifies under UCSF criteria but not Milan
- D No — HCC is an absolute contraindication to transplant
Correct answer: B. No — single tumour must be ≤5 cm; 5.5 cm exceeds Milan criteria
Explanation
The Milan criteria for liver transplantation in HCC (Mazzaferro 1996): single tumour ≤5 cm, or up to 3 nodules each ≤3 cm, no macrovascular invasion, no extrahepatic spread. A 5.5 cm tumour exceeds Milan criteria. Under the expanded UCSF criteria (single ≤6.5 cm or ≤3 nodules with largest ≤4.5 cm and total ≤8 cm), this patient would qualify — but not under Milan. Most transplant centres still use Milan as the standard.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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