title: Liver transplantation for hepatocellular carcinoma comparing the Milan, UCSF, and Asan criteria: long-term follow-up of a Western single institutional experience.
abstract: BACKGROUND
  In patients with hepatocellular carcinoma (HCC), the outcome after liver transplantation (LT) is excellent if tumor characteristics are within the Milan criteria (MC). Expanded Asan criteria (AC) have not yet been validated in Western countries.
  
  
  METHODS
  A total of 76 patients with HCC underwent LT. Patients were divided and compared according to Milan, UCSF, and Asan criteria. Differences between pre- and post-operative assessment were evaluated. Overall survival (OS) and disease-free survival (DFS) were compared between groups. Predictors of recurrence were investigated.
  
  
  RESULTS
  Asan criteria provided 26% and 15% more criteria-fitting patients than MC and UCSF pre-operatively while 49% and 35% at pathological evaluation. Discrepancy between pre- and post-operative evaluation was 32% for MC, 33% for UCSF, and 18% for AC (p = 0.06). After a median follow-up of 70.5 months, patients exceeding MC but fulfilling Asan had comparable 5-yr OS and DFS to patients fulfilling MC (p = 0.17; p = 0.29). Patients exceeding UCSF but fulfilling AC had comparable 5-yr OS and DFS to patients fulfilling UCSF (p = 0.26; p = 0.32). Number of nodules, macro-vascular invasion, capsular invasion, and exceeding AC predicted recurrence at multivariate analysis (p = 0.01, 0.03, 0.01, 0.02, respectively).
  
  
  CONCLUSIONS
  The extension to AC allows increasing the number of patients eligible for LT without affecting OS and DFS.
authors: Department of General, Hepatobiliary and Liver Transplantation Surgery, Ghent University Hospital Medical School, Ghent, Belgium.
authors: Italo
authors: I
authors: Bonadio
authors: Isabelle
authors: I
authors: Colle
authors: Anja
authors: A
authors: Geerts
authors: Peter
authors: P
authors: Smeets
authors: Giammauro
authors: G
authors: Berardi
authors: Marleen
authors: M
authors: Praet
authors: Xavier
authors: X
authors: Rogiers
authors: Bernard
authors: B
authors: de Hemptinne
authors: Hans
authors: H
authors: Van Vlierberghe
authors: Roberto I
authors: RI
authors: Troisi
mesh_terms: D001530:Belgium; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018579:Patient Selection; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
keywords: Asan criteria; Milan criteria; UCSF criteria; expanded criteria; hepatocellular carcinoma; liver transplantation