Background: The Milan Criteria (MC) have historically determined eligibility for transplantation for hepatocellular carcinoma (HCC). The United Network for Organ Sharing (UNOS) Region 4 expanded the criteria for transplantation in HCC to include a single tumor ≤6 cm or up to 3 tumors with the largest diameter ≤5 cm and total additive diameter ≤9 cm (R4C). The aim of this study is to report the 10-year outcomes of this expanded criteria compared to MC.

Methods: Transplants performed for HCC in Region 4 between October 2007 and December 2016 were reviewed using the UNOS database. Recipients were categorized based on imaging findings at initial evaluation.

Results: 2068 patients were included in the study. There was no significant difference in 10-year patient survival between the groups (53% MC vs. 48% R4C, p=0.23). There was also no significant difference in recurrence free survival (54% MC vs. 47% R4C, p=0.15) or allograft survival (53% MC vs. 48% R4C, p=0.16). Finally, there was no significant difference in outcomes between the MC and R4C groups when stratifying patients by locoregional therapy.

Conclusion: This study demonstrates that the criteria for liver transplantation in HCC can be safely expanded to the R4C without compromising outcomes.

CITATION INFORMATION: Commander S., Shaw B., Washburn L., Yoeli D., Rana A., Goss J. A Long-Term Experience with Expansion of Milan Criteria for Liver Transplant Recipients Am J Transplant. 2017;17 (suppl 3).

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