Current Transplantation Reports

, Volume 5, Issue 4, pp 319–326 | Cite as

Liver Transplantation for HCC Beyond Milan

  • Paolo Magistri
  • Russell Rosenblatt
  • Karim J. HalazunEmail author
Liver Transplantation (D Mulligan, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Liver Transplantation


Purpose of the Review

To describe how the field of liver transplantation (LT) for hepatocellular carcinoma (HCC) has expanded beyond the Milan criteria.

Recent Findings

The Milan criteria have been the gold standard selection tool for patients with HCC undergoing LT since 1996. However, soon after its creation, the tumor size and number limits imposed by the Milan criteria were expanded upon by new models, such as the University of California-San Francisco criteria and the Metroticket. Still, these models were always limited by radiological inaccuracy in measuring tumor size and number and, more importantly, did not include any measurement of tumor behavior. Biomarkers, such as alpha-fetoprotein and neutrophil-lymphocyte ratio, provide that missing link and act as effective predictors of biological behavior and, therefore, provide an ability to predict tumor recurrence in patients undergoing LT for HCC, allowing for successful expansion beyond Milan.


More recently, newer scoring systems combine morphometric tumor data with markers of biology. These scoring systems, such as the MORAL score, AFP model, RETREAT score, and Metroticket 2.0, are providing the most accurate pre-LT assessments for HCC recurrence and hold the key to the continued improvement of LT outcomes.


Extended criteria Liver transplantation Liver cancer Hepatocellular carcinoma Biomarkers 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Paolo Magistri
    • 1
  • Russell Rosenblatt
    • 2
  • Karim J. Halazun
    • 3
    Email author
  1. 1.Hepato-Pancreato-Biliary Surgery and Liver Transplantation UnitUniversity of Modena and Reggio EmiliaModenaItaly
  2. 2.Department of Gastroenterology and HepatologyWeill Cornell Medicine CollegeNew YorkUSA
  3. 3.Division of Liver Transplantation and Hepatobiliary Surgery, Department of SurgeryWeill Cornell Medical CollegeNew YorkUSA

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