BACKGROUND: Liver transplantation (LT) plays an important role in the management of patients with hepatocellular carcinoma (HCC). Although early results following LT for HCC were poor, since the introduction of the Milan criteria in 1996 morphological criteria have since been well established. Thereafter, various expansions of the Milan criteria were introduced worldwide. Listing criteria for LT for HCC in the United Kingdom (UK) initially conformed to the Milan criteria but were re-defined in 2009 by expansion of the Milan criteria. AIMS: To look at the evidence in literature on listing criteria and management of HCC worldwide in comparison with the UK. Secondly, we aim to review worldwide vs. UK literature on prioritisation models, loco-regional therapy protocols and role of alpha-fetoprotein (AFP) in LT for HCC. METHODS: An electronic literature search with Medline was carried out to identify articles related to LT for HCC. RESULTS: Although various expansions of the Milan criteria have been described, they remain the gold standard against which other criteria are measured. The UK criteria are an expansion of the Milan criteria that go beyond Milan and University of California, San Francisco (UCSF) criteria. The current UK listing criteria for LT for HCC when compared to the worldwide criteria have a worse survival benefit (projected 5-year survival between 35-50%) when plotted on the metroticket calculator. CONCLUSIONS: In keeping with most transplant centres worldwide, the UK have adopted expansions to Milan to allow more patients to benefit from LT. However, currently, as it stands the UK criteria when plotted in the modification of the Metroticket model project worse survival that would seem unjustified.
BACKGROUND: Liver transplantation (LT) plays an important role in the management of patients with hepatocellular carcinoma (HCC). Although early results following LT for HCC were poor, since the introduction of the Milan criteria in 1996 morphological criteria have since been well established. Thereafter, various expansions of the Milan criteria were introduced worldwide. Listing criteria for LT for HCC in the United Kingdom (UK) initially conformed to the Milan criteria but were re-defined in 2009 by expansion of the Milan criteria. AIMS: To look at the evidence in literature on listing criteria and management of HCC worldwide in comparison with the UK. Secondly, we aim to review worldwide vs. UK literature on prioritisation models, loco-regional therapy protocols and role of alpha-fetoprotein (AFP) in LT for HCC. METHODS: An electronic literature search with Medline was carried out to identify articles related to LT for HCC. RESULTS: Although various expansions of the Milan criteria have been described, they remain the gold standard against which other criteria are measured. The UK criteria are an expansion of the Milan criteria that go beyond Milan and University of California, San Francisco (UCSF) criteria. The current UK listing criteria for LT for HCC when compared to the worldwide criteria have a worse survival benefit (projected 5-year survival between 35-50%) when plotted on the metroticket calculator. CONCLUSIONS: In keeping with most transplant centres worldwide, the UK have adopted expansions to Milan to allow more patients to benefit from LT. However, currently, as it stands the UK criteria when plotted in the modification of the Metroticket model project worse survival that would seem unjustified.
Authors: M Walker; H B El-Serag; Y Sada; S Mittal; J Ying; Z Duan; P Richardson; J A Davila; F Kanwal Journal: Aliment Pharmacol Ther Date: 2016-01-19 Impact factor: 8.171
Authors: Amine Benmassaoud; Roy Nitulescu; Thomas Pembroke; Alex S Halme; Peter Ghali; Marc Deschenes; Philip Wong; Marina B Klein; Giada Sebastiani Journal: Clin Infect Dis Date: 2019-09-27 Impact factor: 9.079
Authors: Savio G Barreto; Simone I Strasser; Geoffrey W McCaughan; Michael A Fink; Robert Jones; John McCall; Stephen Munn; Graeme A Macdonald; Peter Hodgkinson; Gary P Jeffrey; Bryon Jaques; Michael Crawford; Mark E Brooke-Smith; John W Chen Journal: Cancers (Basel) Date: 2022-06-03 Impact factor: 6.575