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Title: Expansion of Liver Transplantation Criteria for Hepatocellular Carcinoma from Milan to UCSF in Australia and New Zealand and Justification for Metroticket 2.0.
Austin Authors: Barreto, Savio G;Strasser, Simone I;McCaughan, Geoffrey W;Fink, Michael A ;Jones, Robert M ;McCall, John;Munn, Stephen;Macdonald, Graeme A;Hodgkinson, Peter;Jeffrey, Gary P;Jaques, Bryon;Crawford, Michael;Brooke-Smith, Mark E;Chen, John W
Affiliation: Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia..
Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW 2050, Australia..
Austin Health
Department of Surgery, The University of Melbourne, Melbourne, VIC 3010, Australia..
Queensland Liver Transplant Service, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia..
South Australia Liver Transplant Unit, Flinders Medical Centre, Adelaide, SA 5042, Australia..
Auckland City Hospital, Auckland 1023, New Zealand..
Issue Date: 3-Jun-2022 2022
Publication information: Cancers 2022; 14(11): 2777
Abstract: Expansion in liver transplantation (LT) criteria for HCC from Milan to UCSF has not adversely impacted overall survival, prompting further expansion towards Metroticket 2.0 (MT2). In this study, we compared patient survival post-transplant before and after 2007 and long-term outcomes for LT within Milan versus UCSF criteria (to determine the true benefit of the expansion of criteria) and retrospectively validated the MT2 criteria. Retrospective analysis of ANZLITR (including all patients transplanted for HCC since July 1997). The entire cohort was divided based on criteria used at the time of listing, namely, Milan era (1997-2006) and the UCSF era (2007-July 2015). The overall 5- and 10-year cumulative survival rates for the entire cohort of 691 patients were 78% and 69%, respectively. Patients transplanted in UCSF era had significantly higher 5- and 10-year survival rates than in the Milan era (80% vs. 73% and 72% vs. 65%, respectively; p = 0.016). In the UCSF era, the 5-year survival rate for patients transplanted within Milan criteria was significantly better than those transplanted outside Milan but within UCSF criteria (83% vs. 73%; p < 0.024). Patients transplanted within the MT2 criteria had a significantly better 5- and 10-year survival rate as compared to those outside the criteria (81% vs. 64% and 73% vs. 50%, respectively; p = 0.001). Overall survival following LT for HCC has significantly improved over time despite expanding criteria from Milan to UCSF. Patients fulfilling the MT2 criteria have a survival comparable to the UCSF cohort. Thus, expansion of criteria to MT2 is justifiable.
DOI: 10.3390/cancers14112777
ORCID: 0000-0002-4999-5657
Journal: Cancers
PubMed URL: 35681757
PubMed URL:
ISSN: 2072-6694
Type: Journal Article
Subjects: Metroticket 2.0
Appears in Collections:Journal articles

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