Liver transplantation for hepatocellular carcinoma: Historical evolution of transplantation criteria

Table 3 Scoring systems for liver transplantation in hepatocellular carcinoma and survival rates stratified according to the recurrence rates

Scoring system	Scores of the parameters						Post-transplant recurrence risk	5-yr DFS in low risk	5-yr OS in low risk	Recurrence in low risk at 5-yr
AFP Model[44], 2012	LTD: ≤ 3 cm; 3-6 cm; > 6 cm. Point: = 0; = 1; = 4		NN: 1-3 nodule; > 4 nodule. Point: = 0; = 2		AFP: ≤ 100; 100-1000; > 1000. Point: = 0; = 2; = 3		Total point = score (0-9): Score ≤ 2, low risk; Score > 2, high risk		67.8; 47.5	8.8; 50.6
RETREAT[45], 2017	LTD + NVT: 0; 1.1-4.9; 5.0-9.9; ≥ 10. Point: = 0; = 1; = 2; = 3		MiVi: Positive. Point: = 2		AFP at LT: 21-99; 21-99; 100-999; ≥ 1000. Point: = 0; = 1; = 2; = 3		Total point = score (0-8): Score = 0; Score < 5, low risk; Score ≥ 5, high risk (RR)			2.9; 75.2
MORAL[46], 2017	Pre-LT-MORAL: LTD > 3 cm; NLR > 5; AFP > 200. Point: = 3; = 6; = 4				Post-LT-MORAL: LTD > 3 cm; NN > 3 nodules; Grade 4 tumor; MiVi positive. Point: = 3; = 2; = 6; = 2		Total point = score (0-13): Score 0-2, low risk; Score 3-6, medium risk; Score 7-10, high risk; Score > 10, very high risk	97.4; 75.1; 49.9; 22.1
NYCA[47] 2018	LTD at diagnosis: 0-3 cm; > 3-6 cm; > 6 cm. Point: = 0; = 2; = 4		NN at diagnosis: 1 nodule; 2-3; ≥ 4. Point: = 0; = 2; = 4		AFP response: AFP always < 200; Point: = 0. Responders: Max > 200-1000 to final < 200; Point: = 2. Max > 1000 to final < 1000 (must be 50% drop); Point: = 2. Nonresponders: Max > 200-400 to final > 200; Point: = 3. Max > 400-1000 to final > 200; Point: = 4. Max > 1000 to final > 1000; Point: = 6		Total point = score (0-14): Score 0-2, low risk; Score 3-6, acceptable risk; Score ≥ 7, high risk	90; 70; 42		Cumulative: 7; 27.5; 62.5
Metroticket 2.0[48], 2018	LTD + NN ≤ 7 and AFP ≤ 200 or LTD + NN ≤ 5 and AFP 200-400 or LTD + NN ≤ 4 and AFP 400-1000						Low risk	87.4	78
SNAPP[49], 2020	LTD: ≤ 3 cm; 3-6 cm; > 6 cm. Point: = 0; = 1; = 2	NN: 1 nodule; 2-3 nodule; ≥ 4 nodule. Point: = 0; = 1; = 2		AFP and PIVKA II: AFP ≤ 150 + PIVKA II ≤ 100; AFP ≤ 150 + PIVKA II > 100; AFP > 150 + PIVKA II ≤ 100; AFP > 150 + PIVKA II > 100. Point: = 0; = 1; = 2; = 3		PET-CT: Isometabolic; Hypermetabolic. Point: = 0; = 1	Total point = score (0-8): Score ≤ 2, low risk; Score 3-4, medium risk; Score > 5, high risk	97; 71; 31		3; 29; 69

AFP: Alpha fetoprotein; DFS: Disease-free survival; LT: Liver transplantation; LTD: Largest tumor diameter; MiVi: Microvascular invasion; NLR: Neutrophile to lymphocyte ratio; NN: Number of nodules; NVT: Number of viable tumors; NYCA: New York/California; OS: Overall survival; PET-CT: Positron emission tomography computed tomography; PIVKA II: Protein induced vitamin K antagonist II; RETREAT: Risk Estimation of Tumor Recurrence After Liver Transplant.