Milan Criteria for Liver Transplantation

Why Use

OLT cures HCC, but the procedure itself is extremely high risk. The Milan Criteria identify patients most likely to benefit from transplantation. Recommended by AASLD guidelines .

When to Use

Patients with hepatocellular carcinoma (HCC) being considered for orthotopic liver transplant (OLT).

Formula

Pearls / Pitfalls

Originally developed by Mazzaferro and colleagues in Milan in 1996 to identify cirrhotic patients with early stage HCC likely to benefit from transplant. Widely validated. HCC as an indication for OLT was controversial before Milan Criteria were published; now it is an accepted indication and still used today in its original iteration. Patients not meeting Milan Criteria at presentation can potentially be downstaged with locoregional therapy such as transarterial chemoembolization (TACE) or radioembolization with Yttrium-90 (Y90), though it is not known whether pre-transplant downstaging reduces post-transplant survival.

Advice

In addition to standard workup for HCC, patients who fulfill the Milan Criteria should undergo full evaluation for OLT, including but not limited to assessment for comorbid conditions, appropriate laboratory studies, calculation of MELD , hepatology consultation, surgical evaluation, and referral to transplant center ( Martin 2014 ). Monitor for potentially treatable hepatic decompensation (ascites, encephalopathy, variceal bleeding).