Milan criteria in liver transplantation

Last revised by Henry Knipe on 3 Mar 2024

The Milan criteria are used to assess suitability in patients for liver transplantation with cirrhosis and hepatocellular carcinoma (HCC) with comparable outcomes when compared to patients with liver cirrhosis but without HCC 3.

The Milan criteria are widely accepted and used, however, there is evidence that less stringent selection criteria (e.g. UCSF criteria) can result in comparable survival outcomes, particularly in patients who undergo locoregional therapy (e.g. ablation, TACE) to down-stage their disease to meet the Milan criteria 3.

Under the Milan criteria, eligibility for liver transplantation is based on the following 1,3:

  • single tumor with a diameter of ≤5 cm, or up to 3 tumors each with a diameter of ≤3 cm

  • no extra-hepatic metastases

  • no major vessel involvement

In addition, the severity of liver disease (determined by the Child-Pugh score) or the presence of portal hypertension may also influence the suitability for transplant ref

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