Comparative analysis of post-transplant mortality and morbidity rates in groups within and beyond the Milan criteria for hepatocellular carcinoma
Öz
Purpose: This study aims to compare the perioperative morbidity and mortality rates in patients undergoing living donor liver transplantation (LDLT) for hepatocellular carcinoma (HCC) who met versus exceeded the Milan criteria based on pathological explant findings.
Materials and Methods: A retrospective analysis was conducted on adult patients undergoing LDLT for HCC. Patients were stratified into two groups: those adhering to Milan criteria (Milan group) and those extending beyond them (Non-Milan group). Demographic characteristics, Model for End-Stage Liver Disease (MELD) scores, and perioperative parameters were evaluated. Postoperative complications were categorized using the Clavien-Dindo classification.
Results: A total of 73 patients were included in the study, with 62 patients within the Milan criteria and 11 patients beyond the criteria. Preoperative evaluation revealed higher MELD scores (23.05±3.46 vs. 10.18±3.16), total bilirubin (2.59±3.35 mg/dL vs. 1.05±0.46 mg/dL), and INR levels (1.47±0.34 vs. 1.23±0.21) in the Milan group, reflecting greater hepatic decompensation. Despite these disparities in hepatic reserve, intraoperative parameters and hospital stay lengths were similar. Crucially, there were no statistically significant differences in early or late major complications (Clavien-Dindo ≥Grade 3).
Conclusion: Patients within the Milan criteria presented with significantly advanced liver failure compared to those exceeding the criteria. These findings suggest that LDLT can be safely performed in selected patients beyond Milan criteria without compromising perioperative safety.
Anahtar Kelimeler
Hepatocellular Carcinoma, Liver Transplantation, Milan Criteria, Postoperative Complications, Clavien-Dindo
Kaynakça
- Llovet JM, Kelley RK, Villanueva A, Singal AG, Pikarsky E, Roayaie S et al. Hepatocellular carcinoma. Nat Rev Dis Primers. 2021;7:6.
- de Sousa JHB, Calil IL, Tustumi F, da Cunha Khalil D, Gonçalves Felga GE, de Arruda Pecora RA et al. Comparison between Milan and UCSF criteria for liver transplantation in patients with hepatocellular carcinoma: a systematic review and meta-analysis. Transl Gastroenterol Hepatol. 2021;6:11.
- Zhu H, Zhao Y, Wang Y, Wei G, Liu J. Understanding the relationship between cuproptosis and the development of hepatocellular carcinoma: implications for targeted therapies. Front Immunol. 2025;16:1358942.
- Bouzari S, Bakhtiari R, Ajoudanifar H, Ataollah S, Shandiz S. Review of the effects of probiotics and their metabolites in the treatment of liver cancer: an update on probiotics as a new treatment. J Clin Pract Res. 2022;45:8-18.
- Lu W, Zhang T, Xia F, Huang X, Gao F. Transarterial radioembolization versus chemoembolization for hepatocellular carcinoma: a meta-analysis. Front Oncol. 2025;14:1298451.
- Galle PR, Forner A, Llovet JM, Mazzaferro V, Piscaglia F, Raoul JL et al. EASL clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2018;69:182-236.
- Sourianarayanane A, El-Gazzaz G, Sanabria JR, Menon KVN, Quintini C, Hashimoto K et al. Loco-regional therapy in patients with Milan Criteria-compliant hepatocellular carcinoma and short waitlist time to transplant: an outcome analysis. HPB (Oxford). 2012;14:325-32.
- Kanižaj TF, Kujundžić PD, Ostojić A, Mijić M, Milić HS, Mijić A et al. Liver transplantation in hepatocellular carcinoma - should we perform downstaging? Croat Med J. 2022;63:317-25.
- Yoh T, Ito T, Ogiso S, Uchida Y, Ishii T, Hatano E. Refining the role of liver transplantation as a curative treatment for hepatocellular carcinoma. Int J Clin Oncol. 2025;30: doi: 10.1007/s10147-025-02898-9.
- Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996;334:693-9.
