Tırnova I, Kanmaz T
Organ Transplantation Center, Koç University Hospital, Istanbul, Türkiye.
Department of Surgery, Division of Organ Transplantation, Başkent University, Istanbul Hospital, Istanbul, Türkiye.
Front Surg. 2025 Jul 10;12:1594361. doi: 10.3389/fsurg.2025.1594361. eCollection 2025.
The Milan Criteria (MC) are widely accepted as the standard patient selection criteria for liver transplantation (LT). However, patients who exceed these criteria may still benefit from transplantation. Various extended criteria have been published. This study aimed to evaluate survival outcomes in hepatocellular carcinoma (HCC) patients undergoing LT, comparing those within and beyond MC, and to review the role of extended criteria in LT.
This retrospective, single-center study included adult patients who underwent LT at Koç University between 2018 and 2024. Pathological data were used to categorize patients into two groups: those within MC and beyond MC. Preoperative data and postoperative overall and disease-free survival rates were compared between these groups. Additionally, a comprehensive literature review of studies evaluating extended criteria for LT in HCC patients was conducted.
A total of 45 adult patients were included in the analysis. There were 23(51.1%) patients within MC, and 22(48.9%) patients in the beyond MC group. Demographics, donor types, graft types, tumor differentiations, Child scores, MELD scores, ischemia times, length of intensive care unit stays, length of hospital stays, and mortality rates were similar ( > 0.05). Tumor count, total tumor diameter, and microvascular invasion rates were statistically higher in patients beyond MC ( < 0.05). Survival analyses revealed no statistically significant differences in 1-year, 3-year, and 5-year survival rates of the patients ( > 0.05).
This study highlights the potential for liver transplantation in HCC patients exceeding the Milan Criteria, with survival outcomes comparable to those within the Milan Criteria in certain cases. Despite numerous studies in the literature, optimal criteria for LT patient selection in beyond MC HCC have not been established. An optimal guideline that will help to better understand tumor behavior, guide the decision-making and timing of liver transplantation (LT), and ultimately improve post-transplant outcomes remains a key objective for future research.
米兰标准（MC）被广泛认可为肝移植（LT）的标准患者选择标准。然而，超出这些标准的患者仍可能从移植中获益。已经公布了各种扩展标准。本研究旨在评估接受LT的肝细胞癌（HCC）患者的生存结果，比较符合和超出MC标准的患者，并探讨扩展标准在LT中的作用。
这项回顾性单中心研究纳入了2018年至2024年在科克大学接受LT的成年患者。利用病理数据将患者分为两组：符合MC标准组和超出MC标准组。比较两组患者的术前数据以及术后总体生存率和无病生存率。此外，还对评估HCC患者LT扩展标准的研究进行了全面的文献综述。
共有45例成年患者纳入分析。符合MC标准组有23例（51.1%）患者，超出MC标准组有22例（48.9%）患者。人口统计学、供体类型、移植物类型、肿瘤分化程度、Child评分、终末期肝病模型（MELD）评分、缺血时间、重症监护病房住院时间、住院时间和死亡率相似（P>0.05）。超出MC标准组患者的肿瘤数量、肿瘤总直径和微血管侵犯率在统计学上更高（P<0.05）。生存分析显示，患者的1年、3年和5年生存率无统计学显著差异（P>0.05）。
本研究强调了超出米兰标准的HCC患者进行肝移植的潜力，在某些情况下其生存结果与符合米兰标准的患者相当。尽管文献中有大量研究，但尚未确立超出MC标准的HCC患者LT的最佳选择标准。制定一个有助于更好地了解肿瘤行为、指导肝移植（LT）决策和时机选择并最终改善移植后结果的最佳指南仍是未来研究的关键目标。
