Liver transplantationThe Impact of Milan Criteria on Liver Transplantation for Hepatocellular Carcinoma: First 15 Years' Experience of the Hungarian Liver Transplant Program
Section snippets
Patients and Methods
We enrolled 412 first OLT patients, including 49 cases of a malignant tumor, 41 of which the neoplasm itself was the indication. Among the 412 patients, 154 (37.4%) were HCV-positive and 258 (62.6%) HCV-negative. We compared the cumulative outcomes of HCV-positive and HCV-negative patients. We also focused on HCC. Because HCC was found only in the HCV-positive group, we evaluated the impact of the Milan criteria on host survival. The following data were recorded: recipient demographics (age,
Results
Among the 412 patients, we verified a primary malignant tumor in 49 cases, including 41 in which the tumor was the indication and 8 in which it was an incidental finding. There were no verified metastases at the time of OLT. Locoregional lymph nodes (hepatogastric ligament) were tumor positive in 4 and negative in 12 cases, and not recognized in 33. Among all OLT patients, there were 154 HCV-positive individuals (37.4%). Hepatocellular carcinoma was verified in 29 cases (18%), including 23
Discussion
Liver transplantation has become a conventional tool to treat patients with hepatocellular carcinoma. HCC occurs mainly in HCV-infected livers, in addition to the majority of cases developing cirrhosis. The BCLC consensus5 presented a therapeutic approach to the different stages of cirrhosis and the tumor. The Milan criteria2 remain a gold standard to consider a patient as an OLT candidate. With the occurrence of various effective ablative techniques, such as RFA and TACE, the size of the HCC
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Cited by (11)
Black race is independently associated with underutilization of transplantation for clinical T1 hepatocellular carcinoma
2022, HPBCitation Excerpt :Liver transplantation provides optimal treatment of the tumor and underlying carcinogenic disease; however, it is hampered by limited organ supply and patients must meet strict criteria to be considered candidates. According to the Milan Criteria, patients with a single tumor less than 5 cm or three or fewer tumors smaller than 3 cm, without angioinvasion or extrahepatic involvement are eligible for transplantation.14 Therefore, surgical resection is the first line treatment for localized tumors according to the National Comprehensive Cancer Network (NCCN), European Association for the Study of the Liver (EASL), and American Association for the study of Liver Diseases (AASLD) guidelines.15–17
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