Comparison Between Milan and UCSF Criteria for Liver Transplantation in Patients with Hepatocellular Carcinoma: a Systematic Review and Meta-analysis

Overview

Journal Transl Gastroenterol Hepatol

Publisher AME Publishing Company

Specialty Gastroenterology

Date 2021 Jan 7

PMID 33409405

Citations 14

Authors

Jorge Henrique Bento de Sousa

Igor Lepski Calil

Francisco Tustumi

Douglas da Cunha Khalil

Guilherme Eduardo Goncalves Felga

Rafael Antonio de Arruda Pecora

Marcio Dias de Almeida

Affiliations

Soon will be listed here.

Abstract

Background: Liver transplantation is the main treatment for hepatocellular carcinoma (HCC). However, because of the limited supply of transplant organs, it is necessary to adopt a criterion that selects patients who will achieve adequate survival after transplantation. The aim of this review is to compare the two main staging criteria of HCC for the indication of liver transplantation (Milan and UCSF) and to analyze the post-transplantation survival rate at 1, 3 and 5 years.

Methods: This is a systematic review and meta-analysis in which scientific articles from 5 databases (PubMed, Lilacs, Embase, Central, and Cinahl) were analyzed. The studies included in the review consisted of liver transplantation in patients with HCC in different subgroups according to donor type (deceased × living), population (eastern × western) and tumor evaluation (radiological × pathological) and adopted the Milan or UCSF criteria for the indication of the procedure.

Results: There was no significant difference between the Milan and UCSF criteria in the overall survival rate at 1, 3 or 5 years, and the overall estimated value found was 1.03 [0.90, 1.17] at 1 year, 1.06 [0.96, 1.16] at 3 years and 1.04 [0.96, 1.12] at 5 years. Regarding the analysis of the subgroups, no significant difference was observed in any of the subgroups with a follow-up of 1, 3 or 5 years.

Conclusions: Both the Milan and UCSF criteria have equivalent survival rate. Thus, less restrictive method would not result in a great loss in the final overall survival rate and would benefit a greater number of patients.

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