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Expanded criteria for liver transplantation in patients with hepatocellular carcinoma
Author(s) -
Yao Francis Y.
Publication year - 2007
Publication title -
hepatology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.123
H-Index - 75
eISSN - 1872-034X
pISSN - 1386-6346
DOI - 10.1111/j.1872-034x.2007.00195.x
Subject(s) - hepatocellular carcinoma , medicine , liver transplantation , milan criteria , transplantation , cadaveric spasm , lesion , orthotopic liver transplantation , surgery , radiology
Following the seminal publication by the group from Milan, Italy using a restrictive set of criteria for orthotopic liver transplantation in patients with hepatocellular carcinoma to limit the risk for tumor recurrence, excellent 5‐year patient survival of greater than 70% after liver transplantation has been reported from many centers using criteria similar to or slightly exceeding the Milan criteria (single lesion of ≤5 cm, or 2–3 lesions of ≤3 cm). The growing experience and success of orthotopic liver transplantation for HCC have also fueled controversies related to expansion of conventional criteria for cadaveric or living‐donor liver transplantation based on tumor size and number. The limitations of imaging studies, exemplified by tumor under‐staging in up to 25% of patients,have been a major concern for liberalizing the current criteria for liver transplantation. The University of California, San Francisco criteria (single lesion of ≤6.5 cm, or 2–3 lesions of ≤4.5 cm with a total tumor diameter ≤8 cm) have been independently tested in several studies, and undergone prospective evaluation based on preoperative imaging. This article provides an in‐depth review of published data on expansion of current criteria for liver transplantation.