The Milan criteria for liver transplantation in hepatocellular carcinoma (HCC) specify which tumour parameters as acceptable for listing?
- A Single tumour ≤7 cm, or up to 5 tumours each ≤5 cm
- B Any number of tumours with total tumour volume <115 cm³
- C Single tumour ≤5 cm, or up to 3 tumours each ≤3 cm, no vascular invasion, no extrahepatic disease ✓
- D Single tumour ≤3 cm, no more than 2 tumours each ≤2 cm
Correct answer: C. Single tumour ≤5 cm, or up to 3 tumours each ≤3 cm, no vascular invasion, no extrahepatic disease
Explanation
Milan criteria (Mazzaferro, 1996): single HCC ≤5 cm, or ≤3 nodules each ≤3 cm, no macrovascular invasion, no extrahepatic metastasis. Within Milan, 5-year survival post-transplant reaches ~75% with <15% recurrence, comparable to transplant for benign disease. The UCSF criteria (single ≤6.5 cm or up to 3 tumours, largest ≤4.5 cm, total ≤8 cm) extend eligibility. Downstaging from beyond Milan to within Milan using locoregional therapy is now accepted at many centres.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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