Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Weill Cornell Medicine, 525 East 68th, F-763, New York, NY, 10065, USA; Center for Liver Disease and Transplantation, Columbia University Medical Center, NY Presbyterian Hospital, 622 West 168th St, PH14-101, New York, NY, 10032, USA.
Center for Liver Disease and Transplantation, Columbia University Medical Center, NY Presbyterian Hospital, 622 West 168th St, PH14-101, New York, NY, 10032, USA; Multi-Organ Transplant, Division of General Surgery, Toronto General Hospital, University of Toronto, 585 University Avenue Toronto, ON, M5G 2N2, Canada.
Int J Surg. 2020 Oct;82S:61-69. doi: 10.1016/j.ijsu.2020.07.029. Epub 2020 Jul 21.
The Milan criteria have been the cornerstone of selection policies for patients with hepatocellular carcinoma (HCC) awaiting liver transplantation (LT) globally for over two decades. Many groups have proposed the transplantation of patients with larger and more numerous tumors achieving comparable results. Many of these use radiologic morphometric criteria as surrogates for explant pathology to predict outcomes. Several other indices have been developed both within and beyond Milan incorporating biological indices as well as dynamic markers of response to pre-transplant locoregional treatments and waiting time. These have allowed for successful expansion of transplant selection criteria without compromising outcomes with limited organ supplies. In this review we will discuss the predictors of outcome in patients beyond Milan criteria.
米兰标准作为全球范围内等待肝移植 (LT) 的肝细胞癌 (HCC) 患者选择政策的基石已经超过二十年。许多团体提出移植更大和更多肿瘤的患者可以获得相当的结果。其中许多使用影像学形态计量学标准作为移植前病理学的替代物来预测结果。其他一些指数已经在米兰标准之外发展起来，包括生物学指数以及对移植前局部治疗和等待时间的反应的动态标志物。这些标准在器官供应有限的情况下成功扩大了移植选择标准，而不会影响结果。在这篇综述中，我们将讨论米兰标准以外的患者的预后预测因子。
