title: Survival after Liver Transplant: Influence of Progression of Disease and of Restoration of the "Milan" Criteria in Patients with Hepato-cellular Carcinoma undergoing Down-staging Procedures.
abstract: OBJECTIVE
  Selection of patients with hepa- to-cellular carcinoma for liver transplantation is gen- erally performed according to the so-called Milan cri- teria. The aim of this study was to learn whether, after down-staging loco-regional therapies, patients origi- nally non-fulfilling the MC (Milan-OUT) meet these criteria (Milan-IN).
  
  
  METHODS
  Between January 2000 and December 2008, 172 patients with HCC re- ceived LT at our Department. Of these, 142 were sub- jected to DS before LT.
  
  
  RESULTS
  Of the 142 patients who received DS, 115 (81%) were Milan-IN and 27 (19%) were Milan-OUT at the time of their enrollment in the waiting list for LT. After a median follow-up of 50 months, overall 1-, 3-, and 5-year survival and dis- ease recurrence-free survival were not significantly different.
  
  
  CONCLUSIONS
  Patients with Milan-OUT HCC can be successfully subjected to LT when they fulfill the MC after being subjected to DS. Imaging progres- sion while on the waiting list is a strong predictor of high rates of HCC recurrence even in patients meet- ing the MC. Lack of imaging progression seems to be a strong predictor of positive LT outcome and should be added to the eligibility criteria for the assessment of LT candidates with HCC.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Giacomoni
authors.forename: Stefano
authors.initials: S
authors.lastname: Di Sandro
authors.forename: Matteo
authors.initials: M
authors.lastname: Donadon
authors.forename: Andrea
authors.initials: A
authors.lastname: Lauterio
authors.forename: Luca
authors.initials: L
authors.lastname: Belli
authors.forename: Iacopo
authors.initials: I
authors.lastname: Mangoni
authors.forename: Plamen
authors.initials: P
authors.lastname: Mihaylov
authors.forename: Giacomo
authors.initials: G
authors.lastname: Concone
authors.forename: Luciano
authors.initials: L
authors.lastname: De Carlis
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018579:Patient Selection; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014850:Waiting Lists