Comparison of survival and tumor recurrence rates in patients undergoing liver transplantation for hepatitis B-related hepatocellular carcinoma using Milan, Shanghai Fudan and Hangzhou criteria

Objectives To assess the performance of theMilan,ShanghaiFudan andHangzhou criteria based on a preoperative evaluation in patients undergoing liver transplantation (LT) for hepatitisB-related hepatocellular carcinoma (HCC). Methods Using a prospectively collected database, the data of consecutive patients with hepatitisB-relatedHCC undergoingLT at the Department of Liver Surgery of Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University fromJanuary 2005 to December 2009 were reviewed. Overall survival and tumor recurrence rates of patients fulfilling theMilan,ShanghaiFudan andHangzhou criteria were compared using log-rank test. Results Altogether 148 patients were enrolled in the study, among whom 88 fulfilled theMilan criteria and 24 and 39 were beyondMilan but within theShanghaiFudan orHangzhou criteria, respectively. After a median follow-up of 44 months, survival rates did not differ among the three groups (P=0.8780). Recurrence rates were significantly higher for newly eligible patients by theShanghaiFudan orHangzhou criteria compared with those within theMilan criteria. Conclusions TheMilan criteria should be used as the preferred criteria for the selection of hepatitisB-relatedHCC for LT. Considering the high tumor recurrence rates and donor scarcity, a moderate expansion of the Milan criteria must be performed cautiously until high-quality clinical trials are conducted.