Comparative Analysis of Hepatocellular Carcinoma Recurrence Rate in Living Donor Liver Transplant Patients: Milan Versus Up-To-Seven Criteria

Background: Primary liver cancer is the most prevalent malignancies. Hepatocellular carcinoma (HCC) constitutes its predominant subtype. Various therapeutic modalities exist for HCC (surgical resection, radiofrequency ablation, transarterial chemoembolization, radioembolization, and liver transplantation (LT)). LT is one of the first-line treatment modalities, with the Milan criteria being accepted as the standard for transplantation. There is concern that the Milan criteria may be restrictive concerning tumor size. Objective: This study aimed to assess recurrence rates of HCC after living donor liver transplantation (LDLT) among cases within Milan criteria or up-to-seven criteria to explore the potential for broadening the criteria without elevating recurrence rates. Methods: This retrospective comparative study was conducted at the Liver Transplantation Unit, Wadi El-Neel Hospital. The study involved 100 cases who underwent LDLT for HCC, based on either Milan criteria or up-to-seven criteria. The cohorts were divided into two groups: Group I (50 cases within Milan criteria) and group II (50 cases within up-to-seven criteria). All cases were subjected to post-operative monitoring for detection of recurrence. Results: There was no significant difference in recurrence rates between cases within Milan criteria and up-to-seven criteria. The mean recurrence rate was 6% in Milan group compared to 14% in up-to-seven group. Conclusion: The up-to-seven criteria are now more useful than before for including HCC cases in LT because they have tumor recurrence rates comparable to Milan criteria. Therefore, they provide a wider range of HCC cases to benefit from LT.