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

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

World J Gastroenterol

HepatoBilioPancreatic Surgery and Transplant Unit, Department of Surgery, Digestive and Metabolic Diseases Institute, Hospital Clínic, University of Barcelona, Barcelona, Catalonia 08036, Spain.

Published: August 2018

AI Article Synopsis

  • Milan criteria are the standard guidelines for liver transplantation for patients with hepatocellular carcinoma, but there are expanded criteria being proposed that show promising results.
  • This article reviews liver transplantation beyond the Milan criteria, focusing on three scenarios: using expanded criteria with deceased donors, downstaging tumors to meet Milan criteria before transplant, and expanding criteria for living donor transplants.
  • The review examines the potential effects of these expansions on waiting list patients, evaluates the effectiveness of the current yes/no criteria versus more continuous survival estimations, and considers the justification for using living donor transplants under expanded criteria.

Article Abstract

Milan criteria are currently the benchmark related to liver transplantation (LT) for hepatocellular carcinoma. However, several groups have proposed different expanded criteria with acceptable results. In this article, we review the current status of LT beyond the Milan criteria in three different scenarios-expanded criteria with cadaveric LT, downstaging to Milan criteria before LT, and expansion in the context of adult living donor LT. The review focuses on three main questions: what would the impact of the expansion beyond Milan criteria be on the patients on the waiting list; whether the dichotomous criteria (yes/no) currently used are appropriate for LT or continuous survival estimations, such as the one of "Metroticket" and whether it should enter into the clinical practice; and, whether the use of living donor LT in the context of expansion beyond Milan criteria is justified.

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6113720PMC
http://dx.doi.org/10.3748/wjg.v24.i32.3626DOI Listing

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