An early regional experience with expansion of milan criteria for liver transplant recipients

J. J. Guiteau, R. T. Cotton, W. K. Washburn, A. Harper, C. A. O'Mahony, A. Sebastian, S. Cheng, G. Klintmalm, M. Ghobrial, G. Halff, L. Mieles, J. Goss

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34 Scopus citations


The Milan Criteria (MC) showed that orthotopic liver transplantation (OLT) was an effective treatment for patients with nonresectable, nonmetastatic HCC. There is growing evidence that expanding the MC does not adversely affect patient or allograft survival following OLT. The adult OLT programs in UNOS Region 4 reached an agreement allowing lesions outside MC (one lesion <6 cm, ≤3 lesions, none >5 cm and total diameter <9 cm-[R4 T3]) to receive the same exception points as MC lesions. Kaplan-Meier curves and log-rank tests were used to compare survival data. Chi-squared and Mann-Whitney U tests were used to compare patient data. A p-value of <0.05 was considered significant. All statistical analyses were performed on SPSS 15 (SPSS, Chicago, IL). Four hundred and forty-five patients were transplanted for HCC (363-MC and 82-R4 T3). Patient demographics were found to be similar between the two groups. Three year patient, allograft and recurrence free survival between MC and R4 T3 were found to be 72.9% and 77.1%, 71% and 70.2% and 90.5% and 86.9%, respectively (all p > 0.05). We report the first regionalized multicenter, prospective study showing benefit of OLT in patients exceeding MC based on preoperative imaging.

Original languageEnglish (US)
Pages (from-to)2092-2098
Number of pages7
JournalAmerican Journal of Transplantation
Issue number9
StatePublished - Sep 2010


  • Milan Criteria
  • expanding Milan Criteria
  • hepatocellular carcinoma
  • liver transplantation

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)


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