Living donor liver transplantation for hepatocellular carcinoma: Milan criteria versus University of California San Francisco

Introduction
Hepatocellular carcinoma (HCC) is the most common primary liver cancer and most patients with HCC also suffer from coexisting cirrhosis. HCC recurrence is a major concern after liver transplant. The Milan criteria was accepted after a good 5 years survival but was criticized for being so restricted and this criticism promoted the appearance of more expanded criteria like the University of California San Francisco (UCSF). Our study compares the results of both Milan and UCSF criteria and the risk factors for recurrence.
Patients and methods
This study included 60 patients had living donor liver transplantation for HCC between January 2011 and December 2016 in Ain Shams Center for Organ Transplantation.They were divided into two groups. Group A: transplanted within the Milan criteria; and group B: transplanted while beyond Milan but within the UCSF criteria. Both groups are compared as regards the recurrence, survival, and risk factors for recurrence.
Results
There is no statistically significant difference between the two groups as regards the survival and recurrence. The 1 and 3 years survival were 86.5 and 71.9% for the Milan group and 81.7 and 61.4% in the group of patients beyond Milan (statistically nonsignificant, =0.348). Seven (15.1%) patients from the Milan group had recurrence while in the beyond Milan group four (28.6%) patients had recurrence (statistically nonsignificant, =0.258). There were no statistically significant difference in microvascular invasion (=0.388), tumor grade (=0.207), and α-fetoprotein (=0.112) between both groups.
Conclusion
Milan criteria can be safely expanded to UCSF with comparable results if responding well to downstaging and with low α-fetoprotein.