Twenty years after: from Milan criteria to a “blended” approach

When Milan criteria (MC) were first proposed in 1996, they rapidly became the cornerstone for the selection of patients with hepatocellular cancer (HCC) waiting for liver transplantation (LT) (1). The use of the MC consented to very well select patients at low risk for post-LT recurrence, thus obtaining excellent survival rates (2). However, twenty years later, it is now clear that the MC are a too restrictive selection criterion, unfortunately excluding too many patients from the potentially curative strategy of LT. Several innovations have been recently introduced in the specific field of tumor oncology and transplant, putting the bases for the creation of new and more refined allocation and selection processes (3).