Summary of Candidate Selection and Expanded Criteria for Liver Transplantation for Hepatocellular Carcinoma: A Review and Consensus Statement

iver transplantation (LT) is accepted as the standard treatment for select patients with hepatocellular carcinoma (HCC) and chronic liver disease. LT achieves oncological clearance and treats the underlying chronic liver disease. The gap between the demand for cadaveric organs and the supply necessitates the use of selection criteria to optimize the utilization of cadaveric grafts for patients with HCC. The use of these criteria must be carefully offset against the potential harm to existing patients without HCC who are also awaiting these scarce organs. Since the introduction and subsequent validation of the Milan criteria in 1996,1 5‐year survival rates greater than 70% have been achieved internationally for patients satisfying the criteria (a solitary HCC with a diameter ≤ 5 cm or as many as 3 lesions with each diameter ≤ 3 cm and no macroscopic vascular invasion or extrahepatic disease). The Milan criteria are now widely accepted and are used as the standard selection criteria for the allocation of cadaveric organs for LT. An analysis of the outcomes of LT for HCC has, however, identified a subgroup of patients who do not satisfy the Milan criteria but nonetheless achieve excellent results. This has prompted a call for the expansion or revision of the selection criteria to optimize resource allocation. Here we review the key issues surrounding the expansion of the selection criteria that were identified at the 2010 International Consensus Conference on Liver Transplantation for Hepatocellular Carcinoma, and we present our recommendations for consensus statements