A Transplant Center’s Experience with Orthotopic Liver Transplantation Outside of the Milan Criteria: Is Expansion of Current Allocation Criteria Justified?

Hepatocellular carcinoma (HCC) is an aggressive cancer that occurs in the liver. It is the fifth most common cancer in the world and the third most common cause of cancer-related death. Several risk factors exist for HCC, including Hepatitis B virus, environmental toxins, Hepatitis C virus, hereditary hemochromatosis, and cirrhosis [1] [2] [3]. There are more than 500,000 new cases of HCC diagnosed every year [4]. As a result, the prevention and treatment of HCC are active areas of research. There are many treatment options available for patients with HCC [1] [3]. Surgical resection is the optimal treatment, but many patients are not candidates for resection because of their tumor burden and/or underlying liver dysfunction [5] [6]. For these patients, liver transplantation is among their other treatment options. The Milan criteria were established in 1996 [7], indicating which patients with HCC, in terms of their tumor burden, would stand to benefit from liver transplantation. These criteria have been accepted by the United Network for Organ Sharing and used to determine priority for donor liver allocation [8] [9]. In recent years, there has been considerable interest regarding the expansion of thes