Expansion of the hepatocellular carcinoma Milan criteria in liver transplantation: Future directions

Table 1 Expanded criteria used for liver transplantation

Criteria	Type of donor	Detailed criteria
UCSF[9,27]	Cadaveric	Solitary tumor ≤ 6.5 cm or ≤ 3 tumors with the largest ≤ 4.5 cm
Up-to-seven[10]	Cadaveric/LDLT	Seven: sum of tumor number and size of the largest tumor without microvascular invasion
Clinica Universidad de Navara (CUN)[12]	Cadaveric	1 tumor ≤ 6 cm or ≤ 3 tumors with the largest ≤ 5 cm
Toso[29]	Cadaveric	Total tumor volume ≤ 115 cm3 and AFP ≤ 400 ng/mL
Hangzhou University[13]	Cadaveric	One of the following: Total tumor diameter ≤ 8 cm Total tumor diameter > 8 cm with histological grade I or II and AFP ≤ 400 ng/mL
Onaca (ITR)[32]	Cadaveric	Solitary tumor, ≤ 6 cm 2-4 tumors, ≤ 5 cm
Tokyo (5-5 rule)[53]	LDLT	Maximum 5 tumors ≤ 5 cm
Kyoto[55]	LDLT	≤ 10 tumors, ≤ 5 cm, DCP§ ≤ 400 mAU/mL
Kyushu University[57]	LDLT	Any number of tumors with diameter ≤ 5 cm or DCP§ ≤ 300 mAU/mL
Asan[58]	LDLT	≤ 6 tumors, diameter ≤ 5 cm
Samsung[59]	LDLT/cadaveric	≤ 7 tumors, diameter ≤ 6 cm, AFP ≤ 1000 ng/mL
BCLC[14]	LDLT	1 tumor, ≤ 7 cm 3 tumors, ≤ 5 cm 5 tumors, ≤ 3 cm Maintained response within Milan criteria during 6 mo after downstaging

AFP: Alpha-fetoprotein; BCLC: Barcelona-Clínic Liver Cancer; DCP: Des-gamma-carboxy prothrombin; LDLT: Living donor liver transplantation; LT: Liver transplantation.