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Liver Transplantation for Hepatocellular Carcinoma: Results of Down-Staging in Patients Initially Outside the Milan Selection Criteria
Open accessAbstract
Conventional criteria for liver transplantation for patients with hepatocellular carcinoma are single HCC ≤ 5 cm or less than or equal to three HCCs ≤ 3 cm. We prospectively evaluated the possibility of slightly extending these criteria in a down-staging protocol, which included patients initially outside conventional criteria: single HCC 5–6 cm or two HCCs ≤ 5 cm or less than six HCCs ≤ 4 cm and sum diameter ≤ 12 cm, but within Milan criteria in the active tumors after the down-staging procedures. The outcome of patients down-staged was compared to that of Milan criteria after liver transplantation and since the first evaluation according to an intention-to-treat principle. From 2003 to 2006, 177 patients with HCC were considered for transplantation: the transplantation rate was comparable between the Milan and down-staging groups: 88/129 cases (68%) versus 32/48 cases (67%), respectively. At a median follow-up of 2.5 years after transplantation, the 1 and 3 years' disease-free survival rates were comparable: 80% and 71% in the Milan group versus 78% and 71% in the down-staging. The actuarial intention-to-treat survival was 27/48 patients (56.3%) in the down-staging and 81/129 cases (62.8%) in the Milan group, p = n.s. The proposed down-staging criteria provide a comparable outcome to the conventional criteria.
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Cited by
EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma
Galle, P. R., Forner, A., Llovet, J. M., Mazzaferro, V., Piscaglia, F., Raoul, J.-L., Schirmacher, P., & Vilgrain, V. (2018) · Journal of Hepatology · doi:10.1016/j.jhep.2018.03.019 · Cited by 11,406
Self-citationLlovet, J. M., Kelley, R. K., Villanueva, A., Singal, A. G., Pikarsky, E., Roayaie, S., Lencioni, R., Koike, K., Zucman-Rossi, J., & Finn, R. S. (2021) · Nature Reviews Disease Primers · doi:10.1038/s41572-020-00240-3 · Cited by 7,055
EASL–EORTC Clinical Practice Guidelines: Management of hepatocellular carcinoma
European Association for the Study of the Liver, & European Organisation for Research and Treatment of Cancer (2012) · Journal of Hepatology · doi:10.1016/j.jhep.2011.12.001 · Cited by 5,218
“In a landmarkmanuscript the so-called Milan criteria were established for patients with a single HCC 65 cmor up to three nodules63 cm [212].”
ResultInfluentialMarrero, J. A., Kulik, L. M., Sirlin, C. B., Zhu, A. X., Finn, R. S., Abecassis, M. M., Roberts, L. R., & Heimbach, J. K. (2018) · Hepatology · doi:10.1002/hep.29913 · Cited by 4,539
AASLD Practice Guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma
Singal, A. G., Llovet, J. M., Yarchoan, M., Mehta, N., Heimbach, J. K., Dawson, L. A., Jou, J. H., Kulik, L. M., Agopian, V. G., Marrero, J. A., et al. (2023) · Hepatology · doi:10.1097/hep.0000000000000466 · Cited by 2,052
Metadata
- Authors
- Ravaioli, M., Grazi, G. L., Piscaglia, F., Trevisani, F., Cescon, M., Ercolani, G., Vivarelli, M., Golfieri, R., D’Errico Grigioni, A., Panzini, I., Morelli, C., Bernardi, M., Bolondi, L., & Pinna, A. D.
- Venue
- American Journal of Transplantation
- Publisher
- Elsevier BV
- Published
- 2008-12
- Volume
- 8
- Issue
- 12
- Pages
- 2547-2557
- ISSN
- 1600-6135 (ISSN-L)
- OpenAlex
- W2026525583
- Cited by
- 363
- References
- 0
- FWCI
- 11.22
- Type
- journal article
- Language
- en
- Open access
- hybrid
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- CoChat. (2026). Citation check: Liver Transplantation for Hepatocellular Carcinoma: Results of Down-Staging in Patients Initially Outside the Milan Selection Criteria. https://app.cochat.ai/papers/10.1111/j.1600-6143.2008.02409.x
- The paper
- Ravaioli, M., Grazi, G. L., Piscaglia, F., Trevisani, F., Cescon, M., Ercolani, G., Vivarelli, M., Golfieri, R., D’Errico Grigioni, A., Panzini, I., Morelli, C., Bernardi, M., Bolondi, L., & Pinna, A. D. (2008). Liver Transplantation for Hepatocellular Carcinoma: Results of Down-Staging in Patients Initially Outside the Milan Selection Criteria. American Journal of Transplantation. https://doi.org/10.1111/j.1600-6143.2008.02409.x
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Bibliographic data: Semantic Scholar, OpenAlex, Crossref.
Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).
Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.
