title: Up-to-7 Criteria for Hepatocellular Carcinoma Liver Transplantation: A Retrospective Analysis of Experiences.
abstract: BACKGROUND
  The expansion of criteria for hepatocellular carcinoma (HCC) liver transplantation should produce satisfactory outcomes in terms of survival and recurrence.
  
  
  OBJECTIVE
  To investigate if the up-to-7 criteria are applicable to liver transplantation for HCC.
  
  
  METHODS
  A review of all liver transplantations performed at our unit between January 2002 and December 2010 was conducted (645 patients). The 91 patients of the sample who had HCC were divided into 3 groups: in Milan criteria (MC; n = 74), in up-to-7 criteria (UTSC; n = 12), and outside of up-to-7 criteria (OUTSC; n = 5). A descriptive retrospective study was carried out to analyze the characteristics of liver tumors and recipients and to estimate recurrence and survival rates for this population of patients.
  
  
  RESULTS
  The characteristics of transplant recipients of the 3 groups were comparable. Statistically significant differences were observed in the number of tumors (1 ± 0.65 for MC, 3 ± 1.05 for UTSC, 6 ± 4.10 for OUTSC; P < .001), largest tumor size (2.47 ± 1.12 cm for MC, 3.78 ± 0.04 cm for UTSC, 4.04 ± 1.73 cm for OUTSC; P < .001), and recurrence (5.4% for MC; 33.3% for UTSC; 20% for OUTSC; P = .008). Survival rates (MC, UTSC, and OUTSC) at 3 and 5 years were 71.6%, 66.7%, and 60%, and 58.1%, 58.3%, and 40%, respectively, whereas tumor-free survival rates were 70.3%, 58.3%, and 60%, and 58.1%, 50%, and 40%, respectively.
  
  
  CONCLUSIONS
  Survival in patients with HCC transplanted under up-to-7 criteria is acceptable. However, the expansion of criteria involves an increase in the number of patients included in the waiting list and a higher probability of relapse.
authors.affiliation: Liver Transplant Unit, Regional Hospital, Málaga, Spain. Electronic address: franjleondiaz@gmail.com.
authors.forename: F J
authors.initials: FJ
authors.lastname: León Díaz
authors.affiliation: Liver Transplant Unit, Regional Hospital, Málaga, Spain.
authors.forename: J A
authors.initials: JA
authors.lastname: Pérez Daga
authors.affiliation: Liver Transplant Unit, Regional Hospital, Málaga, Spain.
authors.forename: B
authors.initials: B
authors.lastname: Sánchez Pérez
authors.affiliation: Liver Transplant Unit, Regional Hospital, Málaga, Spain.
authors.forename: J L
authors.initials: JL
authors.lastname: Fernández Aguilar
authors.affiliation: Liver Transplant Unit, Regional Hospital, Málaga, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Montiel Casado
authors.affiliation: Liver Transplant Unit, Regional Hospital, Málaga, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Aranda Narváez
authors.affiliation: Liver Transplant Unit, Regional Hospital, Málaga, Spain.
authors.forename: M A
authors.initials: MA
authors.lastname: Suárez Muñoz
authors.affiliation: Liver Transplant Unit, Regional Hospital, Málaga, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Romacho López
authors.affiliation: Liver Transplant Unit, Regional Hospital, Málaga, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Santoyo Villalba
authors.affiliation: Liver Transplant Unit, Regional Hospital, Málaga, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Santoyo Santoyo
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014850:Waiting Lists