Milan Criteria

Mazzaferro V, Regalia E, Doci R, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. In 48 patients transplanted within these limits (one nodule ≤ 5 cm or up to three ≤ 3 cm, no vascular invasion or metastases) the 4-year overall survival was 75% and recurrence-free survival 83%.

The Milan criteria remain the international benchmark for listing HCC for liver transplantation and are embedded in UNOS/Eurotransplant allocation. Expanded criteria (UCSF, "up-to-seven", down-staging protocols) allow selected patients beyond Milan to be transplanted with acceptable outcomes; assessment should be by a transplant multidisciplinary team using contrast cross-sectional imaging.