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Milan Criteria for Liver Transplantation

Calculators  Gastrointestinal
Milan criteria is effecient method which reflects the patient suitablity for liver transplant suffering from cirrhosis and hepatocellular carcinoma
Single tumor with diameter ≤5 cm
No 0
Yes 1
Up to 3 tumors each with diameter ≤3 cm
No 0
Yes 1
Extra-hepatic involvement
No 1
Yes 0
Major vessel involvement
No 1
Yes 0
Result:

Background

Measured Factor
Milan criteria
Measured Factor Disease
  • liver cirrhosis and hepatocellular carcinoma
Measured Factor Detail
Milan criteria provides a estimate of whether a patient with cirrhosis and hepatocellular carcinoma is viable candidate for liver transplant or nor.
Speciality
Gastroenterologist
Body System
Gastrointestinal

Result Interpretation

Ranges Ranges
Test Limitations
This criteria lacks in providing pre-LT information about microvascular invasion.
References: 2

Studies

Study Validation 1
The objective of this prospective study was to validate the Milan criteria in order to identify those patients with hepatocellular carcinoma (HCC) who are eligible for liver transplantation. It included 243 patients with hepatocellular carcinoma were involved in the study. Milan criteria was applied on all the patients and 210 patients were eligible for liver transplantation. After liver transplantation median follow up study was carried for 59.7 months. Results showed survival after transplantation at 1, 3 and 5 year was  94%, 76%, and 69% which clearly the beneficial effect of liver transplantation. This study concluded that Milan criteria can be clinically utilized to identify patients with hepatocellular carcinoma (HCC) who are eligible for liver transplant
References: 3
Study Validation 2
The main aim of the study was to compare the outcomes of orthotopic liver transplantation (OLT) in patients with hepatocellular cancer (HCC) using Milan and UCSF criteria. Data was obtained from the United Network of Organ Sharing (UNOS) database and 1972 patients were scrutinized who had undergone OLT for HCC. 1973 patients were identified by Milan criteria and 59 with UCSF criteria. Clinical factors, pathologic factors and overall survival were compared between Milan and UCSF criteria. Results showed overall survival was similar in both the groups. This study concluded that overall survival will remain same when using Milan and UCSF criteria.
References: 4
Study Additional 1
The aim of this retrospective study was to examine the outcomes of elderly hepatocellular carcinoma (HCC) living donor liver transplantation (LDLT) subjects which meet Milan criteria. Data from 110 recipients were collected and evaluated. Patients were divided into two groups: Group E (≥ 60 years) and Group Y (<60 years). Multivariate analysis was applied to find out any association of age as prognosis factor for long term survival. Results showed that there was no significant difference in survival rates among group E and Y. This study concluded that elderly HCC recipients had similar LDLT outcomes and overall survival with younger HCC recipients.
References: 5
Study Additional 2
This case-control, retrospectively study was aimed to determine the beneficial effects of Sorafenib in patients with hepatocellular carcinoma (HCC) who falls beyond Milan’s criteria.17 patients who were beyond the Milan criteria undergoing Orthotopic liver transplantation (OLT) were selected in the study. Patients were classified into 3 groups adjuvant (OLT+ Sorafenib, n = 5), palliative (OLT, n = 6), and control groups (n = 6) and overall survival rate was measured. Results showed patients in adjuvant had more overall survival rates compared to the other two groups
References: 6

References

  1. Mazzaferro V, Bhoori S, Sposito C, Bongini M, Langer M, Miceli R, et al. Milan criteria in liver transplantation for hepatocellular carcinoma: An evidence-based analysis of 15 years of experience. Liver Transpl. 2011 Oct;17 Suppl 2:S44-57
  2. Elshamy M, Aucejo F, Menon KV, Eghtesad B. Hepatocellular carcinoma beyond Milan criteria: Management and transplant selection criteria. World J Hepatol. 2016;8(21):874-80.
  3. Sapisochin G, Goldaracena N, Laurence JM, Dib M, Barbas A, Ghanekaret A, et al. The extended Toronto criteria for liver transplantation in patients with hepatocellular carcinoma: A prospective validation study. Hepatology. 2016;64(6):2077-2088.
  4. Patel SS, Arrington AK, Mckenzie S, Mailey B, Ding M, Lee W, et al. Milan Criteria and UCSF Criteria: A Preliminary Comparative Study of Liver Transplantation Outcomes in the United States. Int J Hepatol. 2012;2012:253517.
  5. Li HY, Wei YG, Yan LN, Li B. Outcomes Between Elderly and Young Hepatocellular Carcinoma Living Donor Liver Transplantation Recipients: A Single-Center Experience. Medicine (Baltimore). 2016;95(5):e2499.
  6. Toso C, Asthana S, Bigam DL, Shapiro AM, Kneteman NM. Reassessing selection criteria prior to liver transplantation for hepatocellular carcinoma utilizing the Scientific Registry of Transplant Recipients database. Hepatology. 2009;49(3):832-8.