Influence on the other patients in the waiting list when expanding the Milan criteria

The extended criteria beyond the Milan have been a matter of debate regarding liver transplantation for patients with hepatocellular carcinoma (HCC). Hangzhou criteria are unique in providing an opportunity of liver transplantation for patient with a large HCC over 8 cm provided that the histology grade is favorable and AFP level is less than 400 ng/mL. The present paper successfully demonstrated the non-inferiority of the Hangzhou criteria in terms of both the patient survival and the recurrence free survival when compared to the other criteria among the 6,554 patients with HCC undergoing liver transplantation from the China Liver Transplant Registry. Another important point includes the influence of the expanded criteria of HCC on non-HCC patients. It may vary widely, depending on the composition of the waiting list population and the scarcity of available liver grafts in the corresponding transplant region and in the individual institution. A morality on waiting list should be kept in spite of the expanded criteria for HCC patients.