Liver transplantation in malignant disease

Table 1 Selection criteria for liver transplantation in hepatocellular carcinoma

Criteria	Definition	Overall survival, (%)	Comment
Milan criteria (MC) (1996)[5]	Single tumor ≤ 5 cm	75% (4-yr OS)	Gold standard
	2-3 tumors ≤ 3 cm	92% (4-yr OS; inside MC at pathological examination)	Validated by many subsequent studies
	No macrovascular involvement
	No extrahepatic disease
UCSF (2001)[28,163]	Single tumor ≤ 6.5 cm	90% (1-yr OS)	Initial definition on pathological examination
	3 tumors all ≤ 4.5 cm with total tumor diameter ≤ 8 cm	75% (5-yr OS)
			Subsequently validated in preoperative imaging
Up-to seven (2009)[29]	Sum of the number of tumors and diameter of the largest tumor (in cm) ≤ 7	64% (beyond MC but within up-to-seven)
		Without microvascular invasion: 71%
		With microvascular invasion 47%
Navarro criteria (2008)[32]	1 tumor ≤ 6 cm	92% (1-yr OS)
	2-3 tumors ≤ 5 cm	73% (5-yr OS)
Valencia criteria Silva et al[34] (2008)	Up to 3 tumors, each ≤ 5 cm, and a cumulative tumor burden ≤ 10 cm	69% (5-yr OS)
		Recurrence probability: 12% and 28% after 1 and 5 yr, respectively
TTV (2008)[164]	TTV ≤ 115 cm3	80% (5-yr OS)	In some centers only LDLT for those beyond MC
	AFP ≤ 400 ng/mL[165]
ETC (2011)[31]	No limits in size and number	68% (beyond MC but inside ETC)
	No vascular invasion	68% (5-yr OS)[37]
	No extrahepatic disease
	No cancer-related symptoms
	Biopsy of the largest lesion not poorly differentiated
Asan criteria (2008)[33]	Largest tumor diameter ≤ 5 cm	76% (5-yr OS)	LDLT
	Number of HCC lesions ≤ 6
	No vascular invasion
Kyoto criteria (2007)[166]	Number of lesions ≤ 10	Beyond MC but within Kyoto criteria: 65% 5-yr OS	LDLT
	Size of the largest lesion ≤ 5 cm
		82% (5-yr OS)[38]
	DCP ≤ 400 mAU/mL
Kyushu criteria (2011)[167,168]	Any number of tumors with a maximum diameter ≤ 5 cm	- 81% (5-yr OS)[169]	LDLT
	DCP < 300 mAU/mL
Tokyo criteria 8 (5-5 rule)[30,35]	Up to 5 tumors	80% (5-yr OS)	LDLT
	Maximum diameter ≤ 5 cm
Samsung[170]	Maximum tumor size ≤ 6 cm	90% RFS after 5 yr	LDLT
	Number of tumors ≤ 7
	AFP ≤ 1000 ng/mL
5-5-500[41]	Up to 5 tumors	- 76% (5-yr OS)	LDLT
	Maximum diameter ≤ 5 cm-
	AFP ≤ 500 ng/mL
Portal vein invasion
Seoul National University Hospital[43]	PV tumor thrombus does not extend into the main PV	11 patients	LDLT
		64% (5-yr OS)
		46% (5-yr RFS)
	AFP × DCP score ≤ 20000 Additional risk factors for recurrence:
	Tumor size > 7 cm
	Preop. FDG-PET SUV ratio ≥ 2.1
	Vp4 infiltration

AFP: Alpha-fetoprotein; DCP: Des-γ-carboxy prothrombin; ETC: Extended Toronto criteria; FDG: Fluorodeoxyglucose; HCC: Hepatocellular carcinoma; LDLT: Living-donor liver transplantation; MC: Milan criteria; OS: Overall survival; PV: Portal vein; PET: positron emission tomography; RFS: Relapse-free survival; SUV: Standardized uptake value; TTV: total tumor volume; UCSF: University of California San Francisco.

Table 2 2007 Milan neuroendocrine tumor criteria[143]

Inclusion criteria
Histology G1/G2 neuroendocrine tumor with or without syndrome
Primary tumor drained by the portal system (pancreas and intermediate gut: from distal stomach to sigmoid colon)
Primary tumor removed with a curative resection (pretransplant removal of all extrahepatic tumor deposits) through surgical procedures separate from transplantation
Less than 50% tumor load in the liver parenchyma
Response to treatment or stable disease for at least 6 mo pretransplantation
Age younger than 55 yr (relative criteria)
Exclusion criteria
High-grade neuroendocrine carcinomas
General contraindications for liver transplantation, including previous tumors
Non-gastrointestinal NET or tumors not drained by the portal system

NET: Neuroendocrine tumor.