In transplantation medicine, the Milan criteria are set of criteria applied in consideration of patients with cirrhosis and hepatocellular carcinoma (HCC) for liver transplantation with intent to cure their disease. Their significance derives from a landmark 1996 study in 48 patients by Mazzaferro et al which showed that selecting cases for transplantation according to specific strict criteria led to improved overall and disease-free survival at a four-year time point.[1] These same criteria have since been adopted by the Organ Procurement and Transplantation Network (OPTN) in the evaluation of patients for potential transplantation.The threshold Milan criteria are as follows:
one lesion smaller than 5 cm; alternatively, up to three lesions, each smaller than 3 cm
Under current OPTN/ONUS guidelines, patients with cirrhosis and HCC who meet these criteria may be considered for transplantation.[2] Depending on the treatment algorithm, additional factors such as advanced liver disease (as classified by Child-Pugh score) or evidence of portal hypertension may also affect suitability for transplantation.[citation needed]
Given the limitations of the original Mazzaferro study, including the small number of patients and limited inclusion criteria, there is ongoing discussion and controversy regarding the appropriate criteria for transplant. Additional studies attempting to replicate outcomes of the Mazzaferro study using Milan criteria thresholds have reported slightly less favorable five-year survival statistics, ranging from 50% to 70%.[3]
Some have advocated for the use of expanded guidelines for liver transplantation in the setting of HCC. In 2003, Yao et al. reported experience at the University of California San Francisco five-year post-transplantation survival of 75% in patients with tumors as large as 6.5 cm, or up to three lesions each less than 4.5 cm with cumulative tumor burden ≤8 cm.[4] Additional studies using these so-called "UCSF criteria" have shown favorable post transplant outcomes,[5] although also higher rates of post transplant recurrence and higher rates of disease progression while waiting for transplant.[6]
^Mazzaferro, Vincenzo; Regalia, Enrico; Doci, Roberto; Andreola, Salvatore; Pulvirenti, Andrea; Bozzetti, Federico; Montalto, Fabrizio; Ammatuna, Mario; Morabito, Alberto (1996-03-14). "Liver Transplantation for the Treatment of Small Hepatocellular Carcinomas in Patients with Cirrhosis". New England Journal of Medicine. 334 (11): 693–700. doi:10.1056/nejm199603143341104. ISSN 0028-4793. PMID 8594428.
^Wald, Christoph; Russo, Mark W.; Heimbach, Julie K.; Hussain, Hero K.; Pomfret, Elizabeth A.; Bruix, Jordi (2013-02-01). "New OPTN/UNOS Policy for Liver Transplant Allocation: Standardization of Liver Imaging, Diagnosis, Classification, and Reporting of Hepatocellular Carcinoma". Radiology. 266 (2): 376–382. doi:10.1148/radiol.12121698. ISSN 0033-8419. PMID 23362092.
^Yao, F. Y. (October 2008). "Liver transplantation for hepatocellular carcinoma: beyond the Milan criteria". American Journal of Transplantation. 8 (10): 1982–1989. doi:10.1111/j.1600-6143.2008.02351.x. ISSN 1600-6143. PMID 18727702.
^Yao, Francis Y.; Ferrell, Linda; Bass, Nathan M.; Watson, Jessica J.; Bacchetti, Peter; Venook, Alan; Ascher, Nancy L.; Roberts, John P. (2001-06-01). "Liver transplantation for hepatocellular carcinoma: Expansion of the tumor size limits does not adversely impact survival". Hepatology. 33 (6): 1394–1403. doi:10.1053/jhep.2001.24563. ISSN 1527-3350. PMID 11391528.
^Duffy, John P.; Vardanian, Andrew; Benjamin, Elizabeth; Watson, Melissa; Farmer, Douglas G.; Ghobrial, Rafik M.; Lipshutz, Gerald; Yersiz, Hasan; Lu, David S. K. (2007). "Liver Transplantation Criteria For Hepatocellular Carcinoma Should Be Expanded". Annals of Surgery. 246 (3): 502–511. doi:10.1097/sla.0b013e318148c704. PMC1959350. PMID 17717454.
^Tang, An; Fowler, Kathryn J.; Chernyak, Victoria; Chapman, William C.; Sirlin, Claude B. (2017-06-13). "LI-RADS and transplantation for hepatocellular carcinoma". Abdominal Radiology. 43 (1): 193–202. doi:10.1007/s00261-017-1210-8. hdl:1866/28271. ISSN 2366-004X. PMID 28612162.
January 01, 1970
milan, criteria, transplantation, medicine, criteria, applied, consideration, patients, with, cirrhosis, hepatocellular, carcinoma, liver, transplantation, with, intent, cure, their, disease, their, significance, derives, from, landmark, 1996, study, patients,. In transplantation medicine the Milan criteria are set of criteria applied in consideration of patients with cirrhosis and hepatocellular carcinoma HCC for liver transplantation with intent to cure their disease Their significance derives from a landmark 1996 study in 48 patients by Mazzaferro et al which showed that selecting cases for transplantation according to specific strict criteria led to improved overall and disease free survival at a four year time point 1 These same criteria have since been adopted by the Organ Procurement and Transplantation Network OPTN in the evaluation of patients for potential transplantation The threshold Milan criteria are as follows one lesion smaller than 5 cm alternatively up to three lesions each smaller than 3 cm no extrahepatic manifestations no evidence of gross vascular invasion Under current OPTN ONUS guidelines patients with cirrhosis and HCC who meet these criteria may be considered for transplantation 2 Depending on the treatment algorithm additional factors such as advanced liver disease as classified by Child Pugh score or evidence of portal hypertension may also affect suitability for transplantation citation needed Contents 1 Controversy and research 2 See also 3 ReferencesControversy and research editGiven the limitations of the original Mazzaferro study including the small number of patients and limited inclusion criteria there is ongoing discussion and controversy regarding the appropriate criteria for transplant Additional studies attempting to replicate outcomes of the Mazzaferro study using Milan criteria thresholds have reported slightly less favorable five year survival statistics ranging from 50 to 70 3 Some have advocated for the use of expanded guidelines for liver transplantation in the setting of HCC In 2003 Yao et al reported experience at the University of California San Francisco five year post transplantation survival of 75 in patients with tumors as large as 6 5 cm or up to three lesions each less than 4 5 cm with cumulative tumor burden 8 cm 4 Additional studies using these so called UCSF criteria have shown favorable post transplant outcomes 5 although also higher rates of post transplant recurrence and higher rates of disease progression while waiting for transplant 6 See also editChild Pugh score Model for End Stage Liver DiseaseReferences edit Mazzaferro Vincenzo Regalia Enrico Doci Roberto Andreola Salvatore Pulvirenti Andrea Bozzetti Federico Montalto Fabrizio Ammatuna Mario Morabito Alberto 1996 03 14 Liver Transplantation for the Treatment of Small Hepatocellular Carcinomas in Patients with Cirrhosis New England Journal of Medicine 334 11 693 700 doi 10 1056 nejm199603143341104 ISSN 0028 4793 PMID 8594428 Wald Christoph Russo Mark W Heimbach Julie K Hussain Hero K Pomfret Elizabeth A Bruix Jordi 2013 02 01 New OPTN UNOS Policy for Liver Transplant Allocation Standardization of Liver Imaging Diagnosis Classification and Reporting of Hepatocellular Carcinoma Radiology 266 2 376 382 doi 10 1148 radiol 12121698 ISSN 0033 8419 PMID 23362092 Yao F Y October 2008 Liver transplantation for hepatocellular carcinoma beyond the Milan criteria American Journal of Transplantation 8 10 1982 1989 doi 10 1111 j 1600 6143 2008 02351 x ISSN 1600 6143 PMID 18727702 Yao Francis Y Ferrell Linda Bass Nathan M Watson Jessica J Bacchetti Peter Venook Alan Ascher Nancy L Roberts John P 2001 06 01 Liver transplantation for hepatocellular carcinoma Expansion of the tumor size limits does not adversely impact survival Hepatology 33 6 1394 1403 doi 10 1053 jhep 2001 24563 ISSN 1527 3350 PMID 11391528 Duffy John P Vardanian Andrew Benjamin Elizabeth Watson Melissa Farmer Douglas G Ghobrial Rafik M Lipshutz Gerald Yersiz Hasan Lu David S K 2007 Liver Transplantation Criteria For Hepatocellular Carcinoma Should Be Expanded Annals of Surgery 246 3 502 511 doi 10 1097 sla 0b013e318148c704 PMC 1959350 PMID 17717454 Tang An Fowler Kathryn J Chernyak Victoria Chapman William C Sirlin Claude B 2017 06 13 LI RADS and transplantation for hepatocellular carcinoma Abdominal Radiology 43 1 193 202 doi 10 1007 s00261 017 1210 8 hdl 1866 28271 ISSN 2366 004X PMID 28612162 Retrieved from https en wikipedia org w index php title Milan criteria amp oldid 1184046199, wikipedia, wiki, book, books, library,
