Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 16, 2022; 10(29): 10413-10427
Published online Oct 16, 2022. doi: 10.12998/wjcc.v10.i29.10413
Liver transplantation for hepatocellular carcinoma: Historical evolution of transplantation criteria
Volkan Ince, Tevfik Tolga Sahin, Sami Akbulut, Sezai Yilmaz
Volkan Ince, Tevfik Tolga Sahin, Sami Akbulut, Sezai Yilmaz, Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
Sami Akbulut, Biostatistics and Medical Informatics, Inonu University Faculty of Medicine, Malatya 44280, Turkey
Author contributions: Ince V, Akbulut S and Sahin TT conceived the project and designed research; Ince V, Akbulut S, Sahin TT and Yilmaz S wrote the manuscript and reviewed the final version.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Sami Akbulut, FACS, MD, PhD, Professor, Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Elazig Yolu 10 Km, Malatya 44280, Turkey.
Received: May 5, 2022
Peer-review started: May 5, 2022
First decision: June 19, 2022
Revised: July 27, 2022
Accepted: August 25, 2022
Article in press: August 25, 2022
Published online: October 16, 2022

Liver transplantation (LT) for hepatocellular carcinoma is still a hot topic, and the main factor that is associated with the success of treatment is to determine the patients who will benefit from LT. Milan criteria have been defined 25 years ago and still is being used for patient selection for LT. However, in living donor LT, the Milan criteria is being extended. Current criteria for patient selection do not only consider morphologic characteristics such as tumor size and number of tumor nodules but also biologic markers that show tumor aggressiveness is also being considered. In the present review article, we have summarized all the criteria and scoring systems regarding LT for hepatocellular carcinoma. All criteria have 5-year overall survival rates that were comparable to the Milan Criteria and ranged between 60%-85%. On the other hand, it was seen that the recurrence rates had increased as the Milan criteria were exceeded; the 5-year recurrence rates ranged between 4.9% to 39.9%. Treatment of hepatocellular carcinoma needs a multidisciplinary approach. Ideal selection criteria are yet to be discovered. The same is true for treatment modalities. The goal will be achieved by a harmonic interplay between basic science researchers and clinicians.

Keywords: Liver transplantation, Hepatocellular carcinoma, Milan criteria, Expanded Malatya criteria

Core Tip: Hepatocellular carcinoma is the third most common cause of cancer-related deaths. Liver transplantation has an important place in the treatment of hepatocellular carcinoma. However, there is no consensus on which patients should receive a liver transplantation. For this reason, various criteria have been defined. In this study, we will discuss the criteria defined by our liver transplant institute in light of a literature analysis.