Liver transplant (LT) listing criteria for patients with hepatocellular cancers (HCC) that exceed the Milan criteria are still controversial. At the University of Toronto, we have transplanted a large cohort of patients with moderate to well differentiated tumors with no macroscopic vascular invasion and no restrictions in size or tumor number. Our initial analysis (Ann Surgery 2011) showed no differences in patient survival between those within and without Milan criteria. We now report a) the long-term follow-up (10-years) of the first cohort and

b) outcomes in a validation cohort.

The analysis compared the original cohort 1 [transplanted 1996-2008; previously published; N=294: with 189(64.3%) Milan-In and 105 (35.7%) Milan-Out] with a new prospective cohort of patients; cohort 2 [2008-2012; N=209: with 124 (59.3%) Milan-In and 85(40.7%) Milan-Out]. The median follow-up from the time of LT was 70 (0-225) months. Last follow-up was November 31, 2014.

Between 1996-2012, 503 patients with a known HCC were transplanted for HCC. The long-term follow-up (5-yr actual and 10-yr actuarial survival) of the cohort 1 group was 72% and 60% (Milan-In) versus 70% and 49% (Milan-Out), p=0.09.

Regarding cohort 2 (validation cohort) there were no differences in sex, preoperative tumor treatment or graft type (living vs deceased donor) between Milan-In and Milan-Out. Differences (Milan-In vs. Milan-Out) were observed in age at transplant (57.6±6.4 vs. 59.6±5.5, p=0.02), HCV diagnosis (54.8% vs. 40%, p=0.03) and waiting time [6.2 (0.1-90) vs. 4.7 (0.1-33) months, p=0.04]. The 1-, 3- and 5-year disease-free survival was 92%, 86% and 83% Milan-In vs. 89%, 75% and 75% Milan-Out, (p=0.2). The 1-, 3- and 5-year actuarial survival was 94%, 82% and 77% Milan-In vs. 95% 79% and 70% Milan-Out, (p=0.6).

The Extended Toronto Criteria provide long-term post-transplant survivals that are similar to the Milan Criteria. This has been prospectively validated in a new cohort of patients.

« Back to 2015 American Transplant Congress