Review Article

Liver Transplantation for Hepatocellular Carcinoma beyond Milan Criteria: Multidisciplinary Approach to Improve Outcome

Table 1

Reported 5-year survival rates in patients undergoing liver transplantation for HCC meeting proposed extended criteria (based on pretransplant versus posttransplant staging).

Author (year)Proposed criteriaPre-LT stagingExplant histology

Yao et al. (2001) [88]One tumor ≤6.5 cm
or ≤3 tumors each ≤4.5 cm
Total tumor diameter ≤8.5 cm
75.2%

Cillo et al. (2004) [94]Any size and number
No poorly differentiated tumor
75%

Kneteman et al. (2004) [114]One single tumor <7.5 cm  
or any number <5 cm
Sirolimus as immunosuppressant
82.9% (4-year-survival)

Ito et al. (2007) [95]≤10 tumor nodules
Tumor diameter ≤5 cm
PIVKA ≤400 mAU/mL
(LDLT)
86.7%

Onaca et al. (2007) [115]One tumor ≤6 cm
or ≤4 tumors each ≤5 cm
>60%

Lee et al. (2008) [96]≤6 tumor nodules
Tumor diameter ≤5 cm
No gross vascular invasion (LDLT)
76.3%

Herrero et al. (2008) [97]One tumor ≤6 cm
or ≤3 tumors ≤5 cm
No macrovascular invasion
No extrahepatic spread
70%

Zheng et al. (2008) [113]Total tumor diameter ≤8 cm
or total tumor diameter >8 cm,
Well differentiated, and AFP ≤400 ng/mL
No macrovascular invasion
72.3%

Mazzaferro et al. (2009) [98]Sum of size (largest tumor)
and number of nodules = 7 (up-to-seven)
No microvascular invasion
71.2%

Muscari et al. (2009) [99]≤5 tumor nodules
Tumor diameter ≤5 cm
77%76%

Fujiki et al. (2009) [139]≤10 tumor nodules
Tumor diameter ≤5 cm
DCP values ≤ 400 mAU/mL
89%

Dubay et al. (2011) [100]Any size and number
No poor differentiated tumor
72%