The Milan criteria define patient selection for liver transplantation in hepatocellular carcinoma. A patient with three HCC nodules measuring 2.5 cm, 2.0 cm, and 3.5 cm, with no vascular invasion, meets which criteria status?

• A Within Milan criteria
• B Exceeds both Milan and UCSF criteria
• C Within Milan criteria since all tumors are below 5 cm
• D Within UCSF criteria but exceeds Milan criteria ✓

Explanation

Milan criteria for HCC transplantation: single tumor ≤5 cm, or up to 3 tumors each ≤3 cm, no macrovascular invasion, no extrahepatic disease. This patient has three tumors but one measures 3.5 cm (exceeds 3 cm limit for multifocal disease), so they exceed Milan. UCSF criteria (Yao criteria): single tumor ≤6.5 cm, or up to 3 tumors with largest ≤4.5 cm and total diameter ≤8 cm. Here three tumors ≤4.5 cm and total = 8.0 cm meets UCSF exactly. Therefore the patient is within UCSF but outside Milan.

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

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