Richtlijnen - AZ Sint-Lucas

Adapted from: Wiesner, R, Edwards, E, Freeman, R, et al. Model for end-stage liver disease
(MELD) and allocation of donor livers. Gastroenterology 2003; 124:91. (from UptoDate)
E/ MILAN-criteria ( richtlijnen voor transplantatie )
Staging
Milan and UCSF Staging Criteria for Hepatocellular Carcinoma
Single tumor maximum
diameter
Multiple tumors
Maximum Largest tumor
number
size
Total tumor
size
Milan 5.0 cm 3 3.0 cm NA
UCSF 6.5 cm 3 4.5 cm 8.0 cm
Abbreviation: NA, not applicable; UCSF, University of California at San
Francisco
The landmark study of Mazzaferro in 1996 established deceased-donor liver transplantation
(orthotopic liver transplantation, OLT) as a viable option for the treatment of HCC [6]. They
showed that when transplantation was restricted to patients with early HCC (defined as single
lesion ≤5 cm, up to three separate lesions, none larger than 3 cm, no evidence of gross vascular
invasion, and no regional nodal or distant metastases), a four-year survival rate of 75 percent
could be achieved. These criteria have become known as the Milan criteria and have been widely
applied around the world in the selection of patients with HCC for liver transplantation . However
frequent contraindications ( performance status, alcoholism) and depletion of donor livers do
limit the indications for transplantation.