Liver transplantation according to Milan criteria an overview of the past ten years/Transplante de figado de acordo com os criterios de Milao: revisao dos ultimos 10 anos

Background: Orthotopic liver transplantation (OLT) remains an excellent treatment approach for HCC in well-selected candidates. Milan Criteria (MC) (a single tumor up to 5cm or up to 3 tumors none larger than 3.0 cm) is the most widely used criteria for selection of those patients. Our aim is to study the current situation of the MC focusing on patient survival and tumor recurrence free rate from 1 to 5-yrs after OLT over the past 10 years. Material and Methods: We have reviewed 59 papers published between 2000-2009; from Asia (42.3%), Europe (33.9%) and North America (20.4%). 5.525 patients have undergone OLT within MC. The overall patient survival rate and tumor recurrence free rate from 1 to 5-yrs were analyzed. Results: Overall patient survival rates were 1 year (87.26%), 2 years (81.95%), 3 years (77.47%), 4 years (75.24%) and 5 years (72.41 %). We have found tumor recurrence free rate of 80.29% and 71.36% at 1 and 5-yrs, respectively. Conclusion: MC has come to simplify the indication for LT in patients with HCC. The best patient survival rate at 1 and 5 years were in North America (88%) and Asia (76,6%), respectively. On the other hand, Europe had the best tumor recurrence free rate at 5 years (91.8%). KEYWORDS: Liver transplantation/standards; Carcinoma hepatocelular/terapia; Follow-up-studies. Introducao: O transplante de figado (TF) continua sendo o melhor tratamento para pacientes, bem selecionados, portadores de carcinoma hepatocelular. Os criterios de Milao (CM) (tumor unico ate 5 cm e 3 tumores nao maiores que 3 cms) sao os criterios mais usados para estes pacientes. Nosso objetivo e avaliar a situacao atual dos CM principalmente a sobrevida do paciente e a taxa livre de recorrencia tumoral apos 1 a 5 anos do TF, nos ultimos 10 anos. Material e Metodos: Revisamos 59 trabalhos entre 200-2009; da Asia (42,3%), Europa (33,9%) e da America do Norte (20,4%). 5.525 pacientes submeteram-se ao TF com os CM. A sobrevida total dos pacientes e a taxa livre de recorrencia tumoral foram analisados. Resultados: A taxa de sobrevida total dos pacientes foi em 1 ano de (87,26%), 2 anos (81,95%), 3 anos (77,47%), 4 anos (75,24%) e 5 anos (72,41%). A taxa livre de recorrencia tumoral foi de 80,29% e 71,36% em 1 e 5 anos, respectivamente. Conclusao: A melhor taxa de sobrevida dos pacientes foi na America do Norte (88%) e na Asia (76,6%), respectivamente. Por outro lado, a Europa teve a melhor taxa livre de recorrencia de doenca em 5 anos (91,8%). DESCRITORES: Tr