Liver transplantation for hepatocellular carcinoma - factors influencing outcome and disease-free survival

Table 1 Overview of the selection criteria for liver transplantation

Name	Criteria	Ref.
Milan	1 tumor < 5 cm in diameter or	Mazzaferro et al[7]
	≤ 3 tumor nodules, each ≤ 3 cm in diameter
	No extrahepatic manifestation
	No vascular invasion
Up-to-seven criteria (“new Milan”)	Seven as the sum of the size of the largest tumor (in cm) and the number of tumors	Mazzaferro et al[166]
Kyoto	≤ 10 tumors, all ≤ 5 cm in diameter	Takada et al[167]
	PIVKA-II > 400 mAU/mL
UCSF	Solitary tumor ≤ 6.5 cm or	Yao et al[9]
	≤ 3 nodules with largest lesion ≤ 4.5 cm and total tumor diameter ≤ 8 cm
	No gross vascular invasion
Shanghai Fudan	Solitary tumor ≤ 9 cm in diameter or	Fan et al[168]
	≤ 3 lesions with the largest ≤ 5 cm and total tumor diameter ≤ 9 cm
Hangzhou	Total tumor diameter ≤ 8 cm or	Zheng et al[169]
	Total tumor diameter more than 8 cm with histopathological grade I or II and preoperative α-fetoprotein ≤ 400 ng/mL	Lee et al[170]
Asan	Largest tumor diameter ≤ 5 cm
	Hepatocellular carcinoma number ≤ 6
	No gross vascular invasion

Table 2 Overview of prioritization systems in different transplant regions worldwide

Region	Country	Basic listing	Standard exception	Patient benefit
Eurotransplant	Germany		1 tumor > 2 and < 5 cm up to 3 tumors > 1 and < 3 cm	Initial listing with MELD 22; upgrading every 3 mo by 10% mortality risk
	The Netherlands		1 tumor > 2 and < 5 cm up to 3 tumors > 1 and < 3 cm	Initial listing with MELD 20; upgrading every 3 mo by 10% mortality risk
				However, “test of time”: patient must have been on the waiting list for 6 mo prior
	Austria	Possible (if Milan criteria are met); however, irrelevant with center-based allocation	No
Europe	United Kingdom	Single lesion < 5 cm		No prioritization on the waiting list
		Up to 5 lesions < 3 cm
		Single lesion between 5 and 7 cm without progression over 6 mo
		No extrahepatic tumor
		No macrovascular invasion AFP < 1000 U/L
	France	Complex French Liver Allocation Score under consideration of
		Lab-MELD-Scores
		Tumor stage (T2 ranked higher than T1)
		Elapsed waiting time
		Distance between donor and Recipient hospital
	Switzerland		1 tumor > 2 and < 5 cm	Lab-MELD + 1.5 points per month
			up to 3 tumors > 1 and < 3 cm
North America	United States		1 tumor > 2 and < 5 cm	Initial listing with MELD 22; upgrading every 3 mo by 10% mortality risk
			up to 3 tumors > 1 and < 3 cm
South America	Brazil		1 tumor < 5 cm	Initial listing with 20 points, increase to 24 points after 3 mo and 29 points after 6 mo
			up to 3 tumors of less than 3 cm each