Hepatocellular carcinoma and liver transplant: beyond the Milan criteria and the risk of “short-blanket” syndrome

Stefano Gitto, Stefano Di Sandro, Paolo Magistri, Pietro Andreone, Fabrizio Di Benedetto


Liver transplant (LT) is considered the best option for patients with hepatocellular carcinoma (HCC) confined into the liver and generally associated with liver cirrhosis (1). The Milan criteria (MC) represent a milestone in the selection of these patients (2). Therefore, basing on MC, the 5-year survival rate after LT could increase to 70%, with a HCC recurrence rate lower than 10% (2). Despite that, too many patients affected by HCC may not benefit from LT due to a tumor stage beyond the selection criteria. Over the last two decades, authors and physicians tried to overcome the MC exploring the opportunity to safely transplant patients beyond (3). Notably, the donor shortage and the competition between patients listed due to HCC and those listed for other indications, force physicians in selecting candidates with the best transplant benefit (3).