Up-to-Seven Criteria (HCC Liver Transplant, Metroticket)
The up-to-seven (Metroticket) criteria for liver transplantation in hepatocellular carcinoma (Mazzaferro and colleagues 2009).
Open the calculator → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Number of tumors
- 1 tumors
- Diameter of the LARGEST tumor
- 6 cm
- GROSS (macro) vascular invasion
- No
- Extrahepatic spread
- No
Result: within
The tool opens with these values already filled in. Replace them with your own.
What the result means
- Within
- Largest tumor size in cm PLUS the number of tumors is 7 or less, with no gross vascular invasion or extrahepatic spread. 5-year survival 71.2%.
- The sum
- CENTIMETERS PLUS A COUNT - an exchange rate between size and number, not a limit on either. One 6 cm tumor and four 3 cm tumors sit at the same boundary.
- Largest only
- Only the LARGEST tumor size enters the sum; the others contribute 1 each however large. TOTAL BURDEN IS NOT MEASURED. Do not sum diameters.
- The condition
- Published "in the absence of microvascular invasion", which CANNOT BE ASSESSED BEFORE TRANSPLANT. The survival describes patients who turned out on the explant not to have had it.
- Milan
- FULLY CONTAINED within up-to-seven, so up-to-seven can only ADD candidates, never remove them.
- UCSF
- NOT computed here - published renderings diverge on the nodule limit and the operators.
- Scope
- A criterion, NOT a listing decision. MELD allocation, downstaging response, organ availability and center policy all apply.
What you enter
- Number of tumors.
- Diameter of the LARGEST tumor.
- GROSS (macro) vascular invasion - what imaging can actually show.
- Extrahepatic spread.
Full field descriptions
- Number of tumors. Each tumor adds 1 to the sum, including the largest.
- Diameter of the LARGEST tumor. ONLY THIS SIZE ENTERS THE SUM - do not sum the diameters of the others.
- GROSS (macro) vascular invasion - what imaging can actually show. This is NOT microvascular invasion, which the published criterion assumes absent and which cannot be assessed before transplant.
- Extrahepatic spread. Present places the patient outside these criteria regardless of the sum.
How this is calculated
Mazzaferro V, Llovet JM, Miceli R, et al. Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: a retrospective, exploratory analysis. Lancet Oncol. 2009;10(1):35-43. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.