Comparative analysis of post-transplant mortality and morbidity rates in groups within and beyond the Milan criteria for hepatocellular carcinoma

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.