Outcomes after liver transplantation for HCC: a meta-analysis: A meta-analysis of outcomes related to stage, size and number of hepatocellular carcinoma in liver transplant recipients

There is growing interest in extending Milan selection criteria for liver transplantation for HCC. We evaluated the impact of different selection criteria, tumour diameter, and number on overall survival (OS), disease-free survival (DFS) and recurrence after liver transplantation. Liver transplantation beyond Milan criteria resulted in decreased OS, DFS, and increased recurrence, similar to transplantation beyond UCSF criteria. Transplantation with summated tumour diameters >10cm or >9cm showed decreased OS, and DFS respectively. The diameter of the largest tumour when >5cm (vs. ≤5cm) resulted in decreased OS, DFS, and increased recurrence. Transplantation with >3 nodules resulted in reduced OS. These data suggest that liver transplantation for HCC should be limited to single lesion ≤5cm (thus restricted UCSF criteria) or multiple lesions with summated diameters ≤9cm (thus validation of Milan criteria), but also suggest expansion of criteria to allow more than 3 nodules if summated diameters ≤9cm.