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HCC Liver Transplant — RACP Adult Medicine MCQ

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ModerateGastroenterologyHCC Liver TransplantRACP Adult Medicine

A 55-year-old man with hepatitis B cirrhosis has a single 4 cm HCC within Milan criteria. Child-Pugh B (score 8). MELD is 18. He has no portal vein invasion or extrahepatic disease. He is otherwise fit. What is the most appropriate management?

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Correct answer: E — Refer for liver transplant assessment

HCC within Milan criteria (single ≤5 cm, or ≤3 nodules each ≤3 cm, no vascular invasion, no extrahepatic disease) in a cirrhotic patient (Child-Pugh B) is a standard indication for liver transplant assessment. Transplant treats both the cancer and the cirrhosis. TACE or RFA may be used as bridging therapy while awaiting transplant to prevent tumour progression.

Reference: TSANZ – 2024 – Liver Transplant; AASLD 2023; Milan Criteria