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
Milan/UCSF transplant criteria assessed -- see action below based on eligibility
→ IF macrovascular invasion or extrahepatic disease present: liver transplantation is CONTRAINDICATED; refer to hepatobiliary MDT for systemic therapy (sorafenib, lenvatinib, or atezolizumab/bevacizumab per NICE TA474/TA705). IF Milan criteria MET (single up to 5cm OR 2-3 lesions each up to 3cm, no vascular invasion, no extrahepatic): refer to transplant centre for listing; alpha-fetoprotein trajectory important (AFP above 1000 ng/mL or rising: poor outcome even within Milan); bridging therapy while awaiting transplant (RFA, TACE, or SIRT if waiting time above 6 months). IF outside Milan but within UCSF criteria (single up to 6.5cm OR 2-3 lesions each up to 4.5cm, total up to 8cm): discuss with transplant centre -- some UK centres use UCSF or 7-criteria; downstaging therapy (TACE/RFA to reduce to within Milan) may be attempted. IF outside both criteria: non-transplant treatment: BCLC staging guides -- TACE (intermediate, BCLC-B), sorafenib/lenvatinib (advanced, BCLC-C), best supportive care (BCLC-D); hepatobiliary MDT involvement essential; NICE pathway for systemic therapy approval.
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.
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- 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.