Liver Transplantation for HCC in the MELD Era

Liver transplantation is the definitive treatment for hepatocellular carcinoma (HCC) that falls within the Milan criteria (a single lesion <5 cm or 2–3 lesions, each <3 cm). Since 2002, the United Network for Organ Sharing (UNOS) has used the Model for End-stage Liver Disease (MELD) score to determine transplantation priority in its liver allocation system. To ensure that tumors do not grow beyond the Milan criteria while the patient is waiting on the transplantation list, UNOS gives HCC patients MELD exception points, which move the patients up the list.

To determine whether this allocation system influences posttransplantation survival in HCC patients, investigators retrospectively reviewed data from 23,562 adults who underwent liver trans…