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Mazzaferro et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996;334:693-699. PMID 8594428

One-paragraph summary

Prospective experience selecting cirrhotic patients with a single HCC ≤5 cm or up to three tumors each ≤3 cm, without macrovascular invasion or extrahepatic spread, for liver transplantation. Patients meeting the criteria achieved 85% overall and 92% recurrence-free survival at four years, re-establishing transplant as an oncologically credible HCC treatment.

Key findings

  • A simple number-and-size rule selected recipients with outcomes comparable to non-HCC transplantation.
  • Pathology occasionally differed from pre-transplant imaging, exposing staging uncertainty.
  • The criteria linked individual cancer prognosis to scarce-graft utility.

Limitations

  • Small, expert-centre cohort from an earlier imaging and treatment era.
  • Morphology is a proxy for biology and creates an artificial boundary.
  • Results do not determine how far expansion remains acceptable.

Why it matters

Milan became the global transplant benchmark, the comparator for expansion models, and a durable example of how transparent selection can rescue a high-risk therapy.

Cited by wiki pages

  • overview
  • staging and treatment allocation
  • liver transplantation