Up-to-7 Criteria for Liver Transplant in HCC
Expanded liver-transplant criteria for HCC (Mazzaferro 2009): sum of largest tumour size in cm + number of tumours ≤ 7, no microvascular invasion. Compares with Milan criteria (single ≤5 cm or ≤3 ≤3 cm). Used in extended-criteria selection.
Score interpretation
→ List for orthotopic liver transplant. Bridge with TACE / RFA / SBRT to prevent dropout (target <6 month wait). UNOS / ELITA priority.
→ Selected centres offer transplant. Down-staging to Milan with TACE / RFA / Y-90 + 6-month period of stability before listing per UCSF / Italian extended criteria.
→ Transplant generally contraindicated. Locoregional therapy (TACE, Y-90, SBRT) + systemic therapy (atezolizumab + bevacizumab per NICE TA666). Consider trial enrolment.
→ Transplant contraindicated. Systemic first-line (atezolizumab + bevacizumab; durvalumab + tremelimumab; lenvatinib). Best supportive care if poor performance status.
Interpretation bands for the Up-to-7. Apply clinical judgement and local guidance.
References
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.