Milan Criteria vs UCSF Criteria for Liver Transplantation in HCC
Criteria to assess eligibility for liver transplantation in hepatocellular carcinoma (HCC). Milan Criteria (Mazzaferro 1996): single tumour up to 5 cm OR up to 3 tumours each up to 3 cm, no vascular invasion, no extrahepatic disease. UCSF Criteria (Yao 2001, expanded): single tumour up to 6.5 cm OR 2-3 tumours each up to 4.5 cm with total tumour diameter up to 8 cm. Note: milan_criteria_transplant already in file -- this provides comparison and clinical guidance.
Score interpretation
Macrovascular invasion, extrahepatic spread, 4 or more tumours, or tumour size beyond both criteria.
→ Not a transplant candidate on these criteria. Refer to the hepatobiliary MDT for BCLC staging and locoregional or systemic therapy; downstaging may be considered in selected patients without macrovascular invasion or extrahepatic spread.
Within the UCSF expanded limits (Yao 2001) but beyond Milan.
→ Discuss with the transplant centre: expanded-criteria listing is centre-dependent (UK listing follows the NHSBT selection criteria). Downstaging (TACE or ablation) to within Milan may be attempted.
Single tumour ≤ 5 cm or 2–3 tumours each ≤ 3 cm, with no macrovascular invasion or extrahepatic spread (Mazzaferro 1996).
→ Refer to a liver transplant centre for assessment. AFP trajectory matters (AFP above 1000 ng/mL or rising predicts a poorer outcome even within Milan); consider bridging locoregional therapy while waiting.
Interpretation bands for the Milan/UCSF Transplant Criteria. Apply clinical judgement and local guidance.
References
- Mazzaferro V et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996;334(11):693-699.
- Yao FY et al. Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. Hepatology. 2001;33(6):1394-1403.
Related
Curated clinical cross-links plus same-class fallbacks.
- Estradiol (HRT — Hormone Replacement Therapy) · Oestrogen Replacement Therapy
- Allopurinol · Xanthine Oxidase Inhibitor — Urate-lowering Therapy
- Febuxostat · Xanthine Oxidase Inhibitor — Urate-lowering Therapy
- Nicotine · Nicotine replacement therapy (NRT)
- Eliglustat · Glucosylceramide synthase inhibitor (substrate reduction therapy)
- Allopurinol · Xanthine Oxidase Inhibitor — Urate-Lowering Therapy
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.