Liver transplant allocation by milan criteria may exclude eligible HCC patients without survival benefit - a post-hoc analysis of the SiLVER study.
Paul Kupke, Kathrin C Schmitt, Moritz H J Wohlfahrt et al.
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In 30 seconds
This post-hoc analysis of the SiLVER Study evaluated the Milan criteria for liver transplant eligibility in 485 patients with hepatocellular carcinoma (HCC). The study found that broader criteria, such as Up-to-7, classified significantly more patients as eligible (83.9% vs 65.6% for Milan) without showing a survival benefit, as indicated by similar overall survival rates (C-index 0.55-0.57).
Key findings
- Broader criteria classified 83.9% of patients as eligible compared to 65.6% under Milan criteria.
- No significant differences in overall survival (C-index 0.55-0.57) across the criteria.
- Being outside any criterion increased the hazard of recurrence (sHR 2.7-3.6, p < 0.001).
- Discrimination for all criteria was modest, with Metroticket 2.0 showing the highest numerical performance.
Why it matters
The findings suggest that reliance on Milan criteria may unnecessarily exclude eligible HCC patients from liver transplantation, potentially impacting patient outcomes. This raises important considerations for transplant eligibility criteria and patient selection processes.