# Liver transplantation for cancer (Milan criteria and beyond)

Source: https://onco.cc/technologies/liver-transplant-oncology/  
OnCo record `liver-transplant-oncology` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Replacing the whole diseased liver cures both the cancer and the cirrhosis underneath it, for patients whose tumours are small enough.

## Summary

Mazzaferro's Milan criteria (1996: one tumour ≤5 cm or up to three ≤3 cm, no vascular invasion) yield ~70% five-year survival. Expanded criteria (UCSF, up-to-seven, AFP-adjusted) and downstaging with TACE/TARE widen eligibility; living-donor transplantation (Asan Medical Center performs the world's highest volume) relieves organ shortage. Transplantation for unresectable colorectal liver metastases (TRANSMET, 2024) and perihilar cholangiocarcinoma (Mayo protocol) is expanding.

## Fields

- Kind: Technology
- Status: standard-of-care
- Last checked: 2026-09-07
- Principle: Total hepatectomy and grafting removes the tumour and the pre-malignant cirrhotic field; immunosuppression is balanced against recurrence risk.
- Since: 1996
- Strengths: Only therapy that treats cancer and cirrhosis together; Best long-term survival for early HCC
- Limitations: Organ shortage and waiting-list dropout; Lifelong immunosuppression; checkpoint inhibitors before transplant risk rejection

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Milan_criteria
- Wikipedia: https://en.wikipedia.org/wiki/Milan_criteria

## Connected records

- cancers: [Biliary tract cancer (cholangiocarcinoma)](https://onco.cc/cancers/cholangiocarcinoma/), [Colorectal cancer](https://onco.cc/cancers/colorectal/), [Early hepatocellular carcinoma (BCLC 0 and A)](https://onco.cc/cancers/hcc-early/), [Epithelioid haemangioendothelioma](https://onco.cc/cancers/epithelioid-haemangioendothelioma/), [Extrahepatic cholangiocarcinoma (perihilar and distal)](https://onco.cc/cancers/extrahepatic-cholangiocarcinoma/), [Hepatoblastoma](https://onco.cc/cancers/hepatoblastoma/), [Hepatocellular carcinoma](https://onco.cc/cancers/hcc/), [Intermediate hepatocellular carcinoma (BCLC B)](https://onco.cc/cancers/hcc-intermediate/), [Intrahepatic cholangiocarcinoma](https://onco.cc/cancers/intrahepatic-cholangiocarcinoma/), [Vascular tumours (angiosarcoma, epithelioid haemangioendothelioma, kaposiform haemangioendothelioma)](https://onco.cc/cancers/vascular-tumours/)
- fronts: [Surgery & Interventional](https://onco.cc/fronts/surgery/)
- institutions: [Asan Medical Center](https://onco.cc/institutions/asan-medical-center/), [Mayo Clinic](https://onco.cc/institutions/mayo-clinic/)
- terms: [BCLC staging](https://onco.cc/terms/bclc-staging/), [Child-Pugh and ALBI liver-function scores](https://onco.cc/terms/child-pugh-albi/)
- ideas: [Immunotherapy downstaging to transplant with a safe washout](https://onco.cc/ideas/idea-hcc-io-before-transplant/)
- people: [Steve Jobs](https://onco.cc/people/steve-jobs/), [Sung-Gyu Lee](https://onco.cc/people/lee-sung-gyu/)
- pathways: [Organ tropism: seed and soil](https://onco.cc/pathways/organ-tropism-seed-soil/)
- roadmaps: [Surgery roadmap: radical operations → less surgery → no surgery when a drug has done the work](https://onco.cc/roadmaps/surgery-roadmap/)

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