Source Department of Hepatobiliary Surgery and Transplantation, St James's University Hospital, Leeds, United Kingdom.
Liver transplantation is accepted as the standard treatment for selected patients with hepatocellular carcinoma and chronic liver disease. Liver transplantation achieves oncological clearance whilst treating the underlying chronic liver disease. The gap between the demand and supply of cadaveric organs necessitates the use of selection criteria that optimise utilisation of cadaveric grafts for patients with hepatocellular carcinoma. This must be carefully offset against the potential detriment to existing patients without hepatocellular carcinoma also awaiting these scarce organs. With the introduction and subsequent validation of the Milan criteria in 1996, 5 year survival in excess of 70% in patients satisfying the criteria has been achieved in units internationally.
They are now widely accepted and used as standard selection criteria for cadaveric liver transplantation. Analysis of the outcomes of liver transplantation for hepatocellular carcinoma has however identified a subgroup of patients not satisfying the Milan criteria, but in whom excellent results were achieved. This prompted a call for expansion or revision of the selection criteria to optimize resource allocation. This review summarizes the main issues and offers the authors' recommendations presented to the 2010 International Consensus Conference on Liver Transplantation for Hepatocellular Carcinoma.