Milan Criteria

Liver-transplant eligibility in hepatocellular carcinoma

Number of HCC lesions

No measurable tumour (e.g. after down-staging)

Single lesion

2–3 lesions

4 or more lesions

Macrovascular (segmental or greater) invasion

Extrahepatic spread / nodal or distant metastasis

Select the number of lesions and enter the largest diameter

Evidence

Original publication

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%.

New England Journal of Medicine, 1996

Open source

Guideline

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.

Last reviewed: 2026-09

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