Liver transplantation and expanded Milan criteria: does it really work?

Area of Science:

• Hepatobiliary Surgery
• Transplant Oncology
• Surgical Gastroenterology

Background:

• Orthotopic liver transplantation is a key treatment for hepatocellular carcinoma.
• Current Milan Criteria may exclude suitable candidates.
• Institutions are exploring expanded criteria to increase patient eligibility.

Purpose of the Study:

• To evaluate the efficacy of expanded Milan Criteria for hepatocellular carcinoma patients undergoing liver transplantation.
• To compare patient survival and tumor recurrence rates between expanded and standard Milan Criteria.

Main Methods:

• Systematic review of PubMed database (2000-2009) using "expanded Milan criteria" search terms.
• Inclusion of 23 relevant articles after excluding 19 irrelevant or incompatible papers.
• Compilation of 1- to 5-year patient survival and tumor recurrence-free rates.

Main Results:

• Fourteen distinct expanded criteria were identified, with the University of California - San Francisco criteria being the most frequently studied.
• Analysis of compiled data from multiple centers.

Conclusions:

• Expanded Milan Criteria represent a viable approach to broaden eligibility for liver transplantation in hepatocellular carcinoma patients.
• No statistically significant improvements in patient survival or tumor recurrence-free rates were observed when comparing expanded criteria to the original Milan Criteria.