Expansion of the hepatocellular carcinoma Milan criteria in liver transplantation: Future directions

World J Gastroenterol. 2018 Aug 28;24(32):3626-3636. doi: 10.3748/wjg.v24.i32.3626.


Milan criteria are currently the benchmark related to liver transplantation (LT) for hepatocellular carcinoma. However, several groups have proposed different expanded criteria with acceptable results. In this article, we review the current status of LT beyond the Milan criteria in three different scenarios-expanded criteria with cadaveric LT, downstaging to Milan criteria before LT, and expansion in the context of adult living donor LT. The review focuses on three main questions: what would the impact of the expansion beyond Milan criteria be on the patients on the waiting list; whether the dichotomous criteria (yes/no) currently used are appropriate for LT or continuous survival estimations, such as the one of "Metroticket" and whether it should enter into the clinical practice; and, whether the use of living donor LT in the context of expansion beyond Milan criteria is justified.

Keywords: Downstaging; Expanded criteria; Hepatocellular carcinoma; Liver transplantation; Living donor liver transplantation; Milan criteria.

Publication types

  • Review

MeSH terms

  • Adult
  • Carcinoma, Hepatocellular / mortality
  • Carcinoma, Hepatocellular / surgery*
  • Donor Selection / standards
  • Humans
  • Liver Neoplasms / surgery*
  • Liver Transplantation / methods
  • Liver Transplantation / standards*
  • Liver Transplantation / trends
  • Living Donors*
  • Neoplasm Recurrence, Local / epidemiology
  • Patient Selection
  • Treatment Outcome
  • Waiting Lists / mortality*