transplantation medicine Organ transplantation is a medical procedure in which an organ is removed from one body and placed in the body of a recipient, to replace a damaged or missing organ. The donor and recipient may be at the same location, or organs may be transpo ...

, the Milan criteria are set of criteria applied in consideration of patients with

cirrhosis Cirrhosis, also known as liver cirrhosis or hepatic cirrhosis, and end-stage liver disease, is the impaired liver function caused by the formation of scar tissue known as fibrosis due to damage caused by liver disease. Damage causes tissue rep ...

and hepatocellular carcinoma (HCC) for liver transplantation with intent to cure their disease. Their significance derives from a landmark 1996 study in 48 patients by Mazzaferro ''et al'' which showed that selecting cases for transplantation according to specific strict criteria led to improved overall and disease-free survival at a four-year time point. These same criteria have since been adopted by the

Organ Procurement and Transplantation Network The United Network for Organ Sharing (UNOS) is a non-profit, scientific and educational organization that administers the only Organ Procurement and Transplantation Network (OPTN) in the United States, established () by the U.S. Congress in 1984 ...

(OPTN) in the evaluation of patients for potential transplantation.The threshold Milan criteria are as follows: * one

lesion A lesion is any damage or abnormal change in the tissue of an organism, usually caused by disease or trauma. ''Lesion'' is derived from the Latin "injury". Lesions may occur in plants as well as animals. Types There is no designated classif ...

smaller than 5 cm; ''alternatively,'' up to three lesions, each smaller than 3 cm * no extrahepatic manifestations * no evidence of gross vascular invasion Under current OPTN/ONUS guidelines, patients with cirrhosis and HCC who meet these criteria may be considered for transplantation. Depending on the treatment algorithm, additional factors such as advanced liver disease (as classified by Child-Pugh score) or evidence of portal hypertension may also affect suitability for transplantation. __TOC__

Controversy and Research

Given the limitations of the original Mazzaferro study, including the small number of patients and limited inclusion criteria, there is ongoing discussion and controversy regarding the appropriate criteria for transplant. Additional studies attempting to replicate outcomes of the Mazzaferro study using Milan criteria thresholds have reported slightly less favorable five-year survival statistics, ranging from 50% to 70%. Some have advocated for the use of expanded guidelines for liver transplantation in the setting of HCC. In 2003, Yao et al. reported experience at the

University of California San Francisco The University of California, San Francisco (UCSF) is a public land-grant research university in San Francisco, California. It is part of the University of California system and is dedicated entirely to health science and life science. It condu ...

five-year post-transplantation survival of 75% in patients with tumors as large as 6.5 cm, or up to three lesions each less than 4.5 cm with cumulative tumor burden ≤8 cm. Additional studies using these so-called "UCSF criteria" have shown favorable post transplant outcomes, although also higher rates of post transplant recurrence and higher rates of disease progression while waiting for transplant.

References

{{Digestive system procedures Transplantation medicine Hepatology

Controversy and Research

See also

References