A 55-year-old man with Child-Pugh A cirrhosis and hepatocellular carcinoma is being assessed for liver transplantation. His imaging shows a single HCC nodule of 4.5 cm diameter with no vascular invasion and AFP 180 ng/mL. According to the Milan Criteria, is he eligible for liver transplantation?
- A No — Milan criteria require single HCC ≤3 cm
- B Yes — single HCC ≤5 cm without vascular invasion qualifies under Milan criteria ✓
- C No — AFP >100 ng/mL automatically disqualifies
- D Yes, but only if down-staged to <3 cm with locoregional therapy first
Correct answer: B. Yes — single HCC ≤5 cm without vascular invasion qualifies under Milan criteria
Explanation
The Milan Criteria for liver transplantation in HCC (Mazzaferro 1996): single tumour ≤5 cm OR up to 3 tumours each ≤3 cm, with no macrovascular invasion and no extrahepatic disease. This patient has a single 4.5 cm tumour without vascular invasion, which satisfies Milan Criteria. AFP elevation alone does not disqualify under strict Milan criteria, though AFP-based score refinements (e.g., AFP >1000 ng/mL is a relative contraindication in some extended criteria). UCSF and Up-to-7 criteria extend the boundary further.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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