title: Liver transplantation and expanded Milan criteria: does it really work?
abstract: BACKGROUND
  Orthotopic liver transplantation is an excellent treatment approach for hepatocellular carcinoma in well-selected candidates. Nowadays some institutions tend to Expand the Milan Criteria including tumor with more than 5 cm and also associate with multiple tumors none larger than 3 cm in order to benefit more patients with the orthotopic liver transplantation.
  
  
  METHODS
  The data collected were based on the online database PubMED. The key words applied on the search were "expanded Milan criteria" limited to the period from 2000 to 2009. We excluded 19 papers due to: irrelevance of the subject, lack of information and incompatibility of the language (English only). We compiled patient survival and tumor recurrence free rate from 1 to 5-years in patients with hepatocellular carcinoma submitted to orthotopic liver transplantation according to expanded the Milan criteria from different centers.
  
  
  RESULTS
  Review compiled data from 23 articles. Fourteen different criteria were found and they are also described in detail, however the University of California - San Francisco was the most studied one among them.
  
  
  CONCLUSIONS
  Expanded the Milan criteria is a useful attempt for widening the preexistent protocol for patients with hepatocellular carcinoma in waiting-list for orthotopic liver transplantation. However there is no significant difference in patient survival rate and tumor recurrence free rate from those patients that followed the Milan criteria.
authors.affiliation: Liver Transplantation Unit Laboratory of Medical investigation, Department Gastroenterology, School of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Marina Vilela Chagas
authors.initials: MV
authors.lastname: Ferreira
authors.forename: Eleazar
authors.initials: E
authors.lastname: Chaib
authors.forename: Maurício Ursoline do
authors.initials: MU
authors.lastname: Nascimento
authors.forename: Rafael Souza Fava
authors.initials: RS
authors.lastname: Nersessian
authors.forename: Daniel Takeshi
authors.initials: DT
authors.lastname: Setuguti
authors.forename: Luiz Augusto Carneiro
authors.initials: LA
authors.lastname: D'Albuquerque
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D009364:Neoplasm Recurrence, Local; D018579:Patient Selection