Metroticket 2.0 Calculator for Hepatocellular Carcinoma (HCC) Transplant Selection
Metroticket 2.0 transplant selection for hepatocellular carcinoma: combines AFP with the sum of the number of nodules and the diameter of the largest nodule to identify patients with about a 70 % chance of 5-year HCC-specific survival after liver transplantation.
Score interpretation
Predicted 5-year HCC-specific survival after transplantation of about 70 % or more (Mazzaferro 2018).
→ Discuss at the liver transplant / HCC multidisciplinary meeting; listing also depends on response to locoregional therapy and the transplant programme's policy. The Milan criteria (1 nodule ≤ 5 cm, or 2–3 nodules each ≤ 3 cm) remain the reference standard in many programmes.
Predicted 5-year HCC-specific survival after transplantation below about 70 % (Mazzaferro 2018).
→ Hepatobiliary multidisciplinary review: consider downstaging with locoregional therapy (TACE, TARE, ablation) and reassessment; otherwise treatment per BCLC / EASL guidance, including systemic therapy or clinical trials.
Interpretation bands for the Metroticket 2.0. Apply clinical judgement and local guidance.
References
- Mazzaferro V et al. Metroticket 2.0 model for analysis of competing risks of death after liver transplantation for hepatocellular carcinoma. Gastroenterology. 2018;154(1):128-139.
- EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol. 2018;69(1):182-236.
Related
Curated clinical cross-links plus same-class fallbacks.
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.