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Milan Criteria — RACP Adult Medicine MCQ

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ModerateGastroenterology & HepatologyMilan CriteriaRACP Adult Medicine

A 50-year-old man with chronic hepatitis B cirrhosis develops hepatic decompensation (ascites, jaundice). His MELD-Na score is 26. He is listed for liver transplantation. What are the Milan criteria for HCC that determine transplant eligibility?

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Correct answer: E — Single tumour ≤5 cm or up to 3 tumours each ≤3 cm, no vascular invasion, no extrahepatic disease

The Milan criteria (Mazzaferro 1996) define transplant eligibility for HCC: single tumour ≤5 cm OR up to 3 tumours each ≤3 cm, with no macrovascular invasion and no extrahepatic spread. Patients within Milan criteria have excellent post-transplant outcomes (5-year survival ~70–75%). Exceeding Milan criteria significantly worsens recurrence rates. Downstaging with TACE, ablation, or SBRT may bring patients back within Milan criteria for transplant consideration. The UCSF and 'up-to-seven' criteria are more liberal alternatives used by some centres.

Reference: Cancer Council Australia – 2020 – HCC Guidelines; AASLD – 2023 – HCC Guidelines