A novel model measuring the harm of transplanting hepatocellular carcinoma exceeding Milan criteria

Am J Transplant. 2008 Apr;8(4):839-46. doi: 10.1111/j.1600-6143.2007.02138.x. Epub 2008 Mar 2.


No empirical studies have defined the posttransplant survival that would justify expansion of the Milan criteria for liver transplantation of hepatocellular carcinoma. We created a Markov model comparing the survival benefit of transplantation for a patient with >Milan HCC, versus the harm caused to other patients on the waiting list. In the base-case analysis, the strategy of transplanting the patient with >Milan HCC resulted in a 44% increased risk of death and a utility loss of 3 quality-adjusted years of life across the pre- and posttransplant periods for a nationally representative cohort of patients on the waiting list. This harm outweighed the benefit of transplantation for a patient with >Milan HCC having a 5-year posttransplant survival of less than 61%. This survival threshold was most sensitive to geographic variations in organ shortage, with the threshold varying from 25% (Region 3) to >72% (Regions 1, 5, 7 and 9). In conclusion, expansion of the Milan criteria will require demonstrating high survival rates for the newly eligible patients-approximately 61% at 5 years after transplantation. In regions with less severe organ shortage, a more aggressive approach to transplanting these patients may be justified.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Carcinoma, Hepatocellular / surgery*
  • Graft Survival
  • Humans
  • Liver Neoplasms / surgery*
  • Liver Transplantation / mortality
  • Liver Transplantation / physiology*
  • Living Donors
  • Markov Chains
  • Neoplasm Transplantation / adverse effects*
  • Patient Selection
  • Retrospective Studies
  • Survival Analysis
  • Tissue Donors*
  • Treatment Outcome
  • Waiting Lists