Liver transplantation for hepatocellular carcinoma in patients beyond the Milan but within the UCSF criteria

Liver transplantation (LT) is the best therapy for early hepatocellular carcinoma (HCC) in cirrhosis. Whereas the Milan criteria are routinely applied, the University of California San Francisco (UCSF) criteria are occasionally considered in large-volume transplant centers. Poor information is available about the real "gain" in patients' outcome when extending the listing criteria from Milan to UCSF.

Out of 100 patients transplanted for HCC at our center, 4 patients exceeding the Milan but meeting the UCSF criteria were identified. Data of these patients were analysed for the purposes of this study.

Three of them are currently alive after a median follow up of 57 months. One patient died 20 months post-transplant as a result of complications from hepatitis. Of the three who are alive, one underwent surgery for HCC recurrence 81 months post transplant. The remaining two have no evidence of tumor 56 and 57 months post transplant, respectively.

Our results, as well as the reviewed literature, showed that only a small percentage of transplanted HCC patients can be classified as "beyond Milan-within UCSF". These patients seem to have acceptable overall, as well as recurrence free survivals. Large-volume patients' series, intention- to-treat analysis based on the radiological findings and multi-center prospective studies are required, in order to further explore the outcome of patients "beyond Milan-within UCSF" criteria and in order to better define the risk/benefit ratio of a potential expansion of the current listing criteria.