Hepatologists' Perception of the Recipient Registration Criteria for Deceased Donor Liver Transplantation: A Survey in Hokuriku, Japan

A survey was conducted to assess hepatologists' awareness of the expanded registration criteria for deceased donor liver transplantation in patients with hepatocellular carcinoma with decompensated cirrhosis in Japan. Since 2019, the Milan criteria have been supplemented by the 5-5-500 rule, and patients with Child-Pugh class B (CP-B) cirrhosis became eligible in 2024. Among 186 hepatologists, 113 (60.8%) responded to the survey. While 67.3% recognized the Japan criteria, only 30.1% were aware of the inclusion of patients with CP-B disease. Moreover, only 22.1% knew all key updates, including the model for end-stage liver disease-based listing. Despite improved patient outcomes with eligibility expansion, its recognition in clinical practice remains limited. The survey findings highlight the need for enhanced dissemination of the updated criteria through academic societies and improved informative systems.