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Otto and colleagues considered successful downstaging when at least a 30% decrease in the largest diameter of arterial enhancement of targeted lesions was achieved. Patients who fulfilled this criterion underwent liver transplantation regardless of the Milan criteria. Yao and colleagues used the UCSF criteria to define transplant eligibility after downstaging and performed tumour surveillance for at least 3 months before liver transplantation. The maximum diameter of residual tumour enhancement on CT or MRI was used to evaluate staging in these studies. Both studies showed good outcomes (post-transplant patient survival; 73.2% at 5 years, 92% at 2 years respectively). Thus, transplant criteria after downstaging may not necessarily be the Milan criteria as long as http://www.selleckchem.com/products/Aloxistatin.html tumours respond well to locoregional http://en.wikipedia.org/wiki/Resveratrol therapy and remain stable for a period of time before transplant. Based on reported experiences, although a consensus has not been established, it appears that successfully downstaged patients should be observed for at least 3 months before undergoing liver transplantation (14, 19, 50, 52). Biomarkers such as ��-fetoprotein (AFP) or des-��-carboxy prothrombin (DCP), also known as protein induced by vitamin K absence or antagonist-II (PIVKA-II), have received the attention as predictors of recurrence after transplant. Increased AFP and DCP levels can be related to unfavourable pathological features of HCC such as microvascular invasion or poor differentiation, which may have a negative impact in post-transplant outcomes (22, 52�C54). Regarding transplantation criteria after downstaging, Ravaioli et al. (52) selected the patients downstaged to the Milan criteria whose AFP had been ��400?ng/ml during the waiting time. These groups of patients exhibited a 3-year disease-free survival equivalent to patients who underwent liver transplantation with original HCCs within the Milan criteria (71 vs. 71%). Several studies have shown a pre-operative AFP level >1000?ng/ml to be a strong independent predictor of tumour recurrence after liver transplantation (54�C56). In line with this, some investigators recommend http://www.selleckchem.com/products/DMXAA(ASA404).html that for patients with AFP >1000?ng/ml, successful downstaging should include a decrease in the AFP levels