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Milan Criteria / UCSF (Expanded) Criteria

Milan 1996; UCSF 2001

Determines whether hepatocellular carcinoma burden meets the classic Milan criteria and the more permissive UCSF expanded criteria for liver transplant candidacy, using tumor number, lesion diameters, and presence of macrovascular invasion or extrahepatic disease.

Also searched as: HCC · hepatocellular carcinoma · liver transplant · OLT · transplant eligibility · liver · hepatocellular · transplant · cirrhosis

Number of HCC lesions

Viable HCC nodules on pretransplant imaging (after accounting for treated lesions per center protocol).

Largest lesion diameter
cm
2nd largest lesion diameter (if ≥2 tumors)

Required when number of tumors ≥ 2.

cm
3rd largest lesion diameter (if ≥3 tumors)

Required when number of tumors ≥ 3. For >3 tumors, enter the three largest and ensure total diameter is accurate.

cm
Total (summed) tumor diameter

Sum of diameters of all viable lesions. Optional if ≤3 lesions are fully entered; otherwise provide explicitly for UCSF.

cm
Macrovascular invasion and/or extrahepatic disease present

Portal/hepatic vein tumor thrombus, nodal disease beyond regional, or distant metastases on staging.

Information
Incomplete input
  • Please provide: number of tumors and largest lesion diameter.

How this tool works

The Milan criteria (Mazzaferro 1996) remain the reference standard for selecting patients with cirrhosis and HCC for orthotopic liver transplantation, associating single tumors ≤5 cm or up to three tumors each ≤3 cm—without macrovascular invasion or extrahepatic spread—with 5-year survival above 70% and low recurrence. The University of California San Francisco (UCSF) criteria modestly expand size limits (single ≤6.5 cm, or ≤3 tumors with largest ≤4.5 cm and total diameter ≤8 cm) while preserving comparable outcomes in selected series. Both systems require absence of macrovascular invasion and extrahepatic metastases. This calculator reports eligibility under both frameworks side by side so the more permissive UCSF result is visible when Milan is exceeded. Imaging measurements should reflect contrast-enhanced multiphase CT or MRI; pathologic stage may differ after explant.

References

Implemented from the cited published sources. Educational use only; confirm against current guidelines before clinical use.

Clinical questions that use this

Vetting guides that reach for this tool.

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