03-B: Liver Transplant for HCC Should not be Expanded beyond Milan Criteria

Authors:

Julie Heimbach, MD (USA)

In the United States in 2012, nearly 28% of livers were allocated to patients with an HCC MELD exception score.1 Additionally, waitlist drop-out rates are significantly lower and transplant rates are higher for patients with HCC MELD exception score compared non-HCC patients. 2,3 Radiographic criteria for accurate staging of HCC are imprecise and have led to patients being both over and under-staged4. While recent policy changes have occurred which may improve this situation, expansion of criteria beyond Milan to UCSF to other proposed criteria may lead to lead to even greater inaccuracy. While outcomes for transplantation for patients within Milan Criteria are excellent, especially by the standards of other available oncologic treatments, they are still inferior to transplantation for other diagnoses5. Expanding to beyond Milan criteria will not improve outcomes, and will more likely lead to slightly worse outcomes. Given the large numbers of patients already transplanted for HCC, and the greater access to transplantation that patients with HCC already enjoy in the United States, even a slight decrease in outcomes for patients transplanted beyond Milan criteria is hard to accept given the need to maximise outcomes of a scare resource.