Liver transplantation for hepatocellular carcinoma comparing the Milan, UCSF , and Asan criteria: long‐term follow‐up of a Western single institutional experience

Background In patients with hepatocellular carcinoma ( HCC ), the outcome after liver transplantation ( LT ) is excellent if tumor characteristics are within the Milan criteria ( MC ). Expanded Asan criteria ( AC ) have not yet been validated in Western countries. Methods A total of 76 patients with HCC underwent LT . Patients were divided and compared according to Milan, UCSF , and Asan criteria. Differences between pre‐ and post‐operative assessment were evaluated. Overall survival ( OS ) and disease‐free survival ( DFS ) were compared between groups. Predictors of recurrence were investigated. Results Asan criteria provided 26% and 15% more criteria‐fitting patients than MC and UCSF pre‐operatively while 49% and 35% at pathological evaluation. Discrepancy between pre‐ and post‐operative evaluation was 32% for MC , 33% for UCSF , and 18% for AC (p = 0.06). After a median follow‐up of 70.5 months, patients exceeding MC but fulfilling Asan had comparable 5‐yr OS and DFS to patients fulfilling MC (p = 0.17; p = 0.29). Patients exceeding UCSF but fulfilling AC had comparable 5‐yr OS and DFS to patients fulfilling UCSF (p = 0.26; p = 0.32). Number of nodules, macro‐vascular invasion, capsular invasion, and exceeding AC predicted recurrence at multivariate analysis (p = 0.01, 0.03, 0.01, 0.02, respectively). Conclusions The extension to AC allows increasing the number of patients eligible for LT without affecting OS and DFS .