Journal of Liver Cancer

Review Article

Contemporary overview of liver transplantation for intrahepatic cholangiocarcinoma and combined hepatocellular-cholangiocarcinoma: Hae Won Lee; Received January 11, 2026 Accepted March 3, 2026 Published online March 5, 2026; DOI: https://doi.org/10.17998/jlc.2026.03.03 [Accepted]

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Abstract PDF: Historically, intrahepatic cholangiocarcinoma (iCCA) and combined hepatocellular-cholangiocarcinoma (cHCC-CCA) were regarded as absolute contraindications for liver transplantation (LT) due to dismal outcomes characterized by high recurrence rates and poor long-term survival in early experiences. Consequently, these malignancies have been systematically excluded from standard transplant criteria for decades. However, the landscape of transplant oncology is undergoing a significant paradigm shift, driven by a deeper understanding of tumor biology and refined patient selection strategies. Recent multicenter retrospective studies have identified a distinct subgroup of patients-specifically those with "very early" iCCA in the setting of cirrhosis-who achieve excellent post-transplant outcomes comparable to those of hepatocellular carcinoma. This evidence has prompted major international societies to update their guidelines, cautiously opening the door for LT in this selected population. Conversely, cHCC-CCA remains a diagnostic and therapeutic challenge. This narrative review critically analyzes the pivotal data driving the current paradigm shift and synthesizes the latest clinical practice guidelines to provide a contemporary roadmap for the management of iCCA and cHCC-CCA in the transplant setting.

Special Contribution

Impact of the 2024 medical-policy conflict on hepatocellular carcinoma management in Korea: Soon Sun Kim, Hyun Yang, Jieun Kwon, Eunju Kim, Jeong Il Yu, Janghan Jung, Woosun Choi, Ji Eun Han, Moon Haeng Hur, Bo Hyun Kim, Sung Hyun Kim, Jeong Han Kim, Haeryoung Kim, Pyoung-Jae Park, Hyun Phil Shin, Su Jong Yu, Ki Tae Yoon, Sang Min Yoon, Minjong Lee, Jai Young Cho, Jin-Young Choi, Do Young Kim, June Sung Lee, Mi-Sook Kim, Kyung Sik Kim; J Liver Cancer. 2025;25(2):169-177. Published online September 2, 2025; DOI: https://doi.org/10.17998/jlc.2025.09.01

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Abstract PDF: In 2024, a nationwide conflict between the South Korean government and the medical community, the medical-policy conflict, profoundly impacted healthcare delivery. This study aimed to evaluate the changes in the management of hepatocellular carcinoma (HCC) following this crisis. We analyzed retrospective real-world data from university hospitals in the Seoul Metropolitan Area, supplemented with national healthcare data from the Health Insurance Review and Assessment Service. The analytical variables included changes in workforce composition, initial treatment modalities, HCC stage distribution, quality indicators for HCC care, regional and institutional variations in care delivery, and liver transplantation (LT) volume. A comparison between 2023 and 2024 revealed a marked decline in the number of medical trainees, a rise in the proportion of physician assistants, a 28.9% reduction in newly initiated HCC treatments, and an increased rate of stage IV diagnoses. Several quality indicators, including rates of multidisciplinary care and patient education, declined. The volume of LTs decreased by approximately 20% nationwide, with some regions ceasing LT procedures. The results suggest that serious disruptions occurred in HCC care following the conflict. The significant decrease in initial treatment and number of LT procedures, more advanced stages at diagnosis, and declining quality metrics indicate the emergence of healthcare gaps. Without the recovery of the clinical workforce and the reestablishment of a stable healthcare delivery system, the management of serious diseases such as HCC will remain structurally vulnerable. National-level efforts are urgently required to address regional disparities and restore essential medical services.

Review Article

A concise review of updated global guidelines for the management of hepatocellular carcinoma: 2017-2024: Hyunjae Shin, Su Jong Yu; J Liver Cancer. 2025;25(1):19-30. Published online February 10, 2025; DOI: https://doi.org/10.17998/jlc.2025.02.03

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1,092 Downloads
18 Citations

Abstract PDF

Many guidelines for hepatocellular carcinoma (HCC) have been published and are regularly updated worldwide. HCC management involves a broad range of treatment options and requires multidisciplinary care, resulting in significant heterogeneity in management practices across international communities. To support standardized care for HCC, we systematically appraised 13 globally recognized guidelines and expert consensus statements, including five from Asia, four from Europe, and four from the United States. These guidelines share similarities but reveal notable discrepancies in surveillance strategies, treatment allocation, and other recommendations. Geographic differences in tumor biology (e.g., prevalence of viral hepatitis, alcohol-related liver disease, or metabolic dysfunction-associated steatotic liver disease) and disparities in available medical resources (e.g., organ availability, healthcare infrastructure, and treatment accessibility) complicate the creation of universally applicable guidelines. Previously, significant gaps existed between Asian and Western guidelines, particularly regarding treatment strategies. However, these differences have diminished over the years. Presently, variations are often more attributable to publication dates than to regional differences. Nonetheless, Asia-Pacific experts continue to diverge from the Barcelona Clinic Liver Cancer system, particularly with respect to surgical resection and locoregional therapies, which are viewed as overly conservative in Western guidelines. Advancements in systemic therapies have prompted ongoing updates to these guidelines. Given that each set of guidelines reflects distinct regional characteristics, strengths, and limitations, fostering collaboration and mutual complementarity is essential for addressing discrepancies and advancing global HCC care.

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Journal of Functional Foods.2026; 137: 107172. CrossRef
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Mehrad Zare, Alisa Mohebbi, Ali Abdi, Afshin Mohammadi
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Amirreza Taherkhani, Hoornaz Molana, Mahsa Taremi, Ghader Mohammadnezhad
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Maria V. L. de Castro, Milena C. F. de Lima, Gabriela A. da C. Barbosa, Sabrine G. Carvalho, Amanda M. R. M. Coelho, Luciano de S. Santos, Valdenizia R. Silva, Rosane B. Dias, Milena B. P. Soares, Emmanoel V. Costa, Daniel P. Bezerra
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Spectrum of therapeutic options in hepatocellular carcinoma
Hyun Phil Shin, Moonhyung Lee, Jung Won Jeon
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Ioannis Liapis, Ioannis A Ziogas, Charalampos Theocharopoulos, Dimitrios P Moris, Trevor L Nydam, Ana L Gleisner, Richard D Schulick, Georgios Tsoulfas
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Jae Hyon Park, Myung Ji Goh, Dong Hyun Sinn, Jaeseung Shin, Hyungjin Rhee
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Fabiana Crispo, Antonio Vassallo, Immacolata Faraone, Alessandro Santarsiere, Lucia Chiummiento, Mara Martinelli, Nicoletta Cascelli, Xavier Fernàndez-Busquets, Rocchina Miglionico, Ilaria Nigro, Carla Caddeo, Maria Francesca Armentano
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Case Report

Durable complete response after discontinuation of atezolizumab-bevacizumab therapy in patients with hepatocellular carcinoma with portal vein tumor thrombosis: the first report: Pramod Kumar, Pradeep Krishna, Rohit Maidur, Naveen Chandrashekhar, Suresh Raghavaiah; J Liver Cancer. 2025;25(1):134-137. Published online November 5, 2024; DOI: https://doi.org/10.17998/jlc.2024.09.26

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218 Downloads
1 Citation

Abstract PDF

Hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is associated with a dismal prognosis. Atezolizumab plus bevacizumab (atezo-bev) is the recommended palliative treatment, and approximately 10% of the patients may experience a complete response (CR), according to the mRECIST criteria. The treatment duration is until disease progression or unacceptable side effects occur. Long-term continuation can cause potential toxicities and a substantial financial burden, making early treatment discontinuation a viable option. This report describes durable CR after discontinuing atezo-bev treatment in three patients with HCC and PVTT.

Citations

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Immunotherapy in Hepatocellular Carcinoma with Portal Vein Tumour Thrombosis: From Poor Prognosis to Curative-Intent Strategies
Luca Marzi, Rodolfo Sacco, Luisa Siciliani, Saveria Lory Crocè, Mauro Giuffrè, Cristina Stasi, Chiara Turri, Monica Zoeschg, Andrea Mega
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Review Article

Management of early-stage hepatocellular carcinoma: challenges and strategies for optimal outcomes: Jae Hyun Yoon, Sung Kyu Choi; J Liver Cancer. 2023;23(2):300-315. Published online September 21, 2023; DOI: https://doi.org/10.17998/jlc.2023.08.27

19,273 Views
324 Downloads
22 Citations

Abstract PDF

Although hepatocellular carcinoma (HCC) is associated with a poor prognosis, management of early-stage HCC is often successful with highly efficacious treatment modalities such as liver transplantation, surgical resection, and radiofrequency ablation. However, unfavorable clinical outcomes have been observed under certain circumstances, even after efficient treatment. Factors that predict unsuitable results after treatment include tumor markers, inflammatory markers, imaging findings reflecting tumor biology, specific outcome indicators for each treatment modality, liver functional reserve, and the technical feasibility of the treatment modalities. Various strategies may overcome these challenges, including the application of reinforced treatment indication criteria with predictive markers reflecting tumor biology, compensation for technical issues with up-to-date technologies, modification of treatment modalities, downstaging with locoregional therapies (such as transarterial chemotherapy or radiotherapy), and recently introduced combination immunotherapies. In this review, we discuss the challenges to achieving optimal outcomes in the management of early-stage HCC and suggest strategies to overcome these obstacles.

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Case Report

Curative liver transplantation after lung resection for advanced hepatocellular carcinoma with lung metastasis and inferior vena cava tumor thrombosis: a case report: Dong Jin Joo, Do Young Kim, Jinsil Seong, Hyun Jeong Kim, Jae Geun Lee, Dai Hoon Han, Gi Hong Choi, Myoung Soo Kim, Jin Sub Choi, Soon Il Kim; J Liver Cancer. 2021;21(2):181-186. Published online September 30, 2021; DOI: https://doi.org/10.17998/jlc.2021.09.08

6,904 Views
108 Downloads
3 Citations

Abstract PDF

Hepatocellular carcinoma (HCC) with distant metastasis is an absolute contraindication for liver transplantation (LT). However, it is still unclear whether LT is feasible or acceptable in such patients, albeit after being treated with a multidisciplinary approach and after any metastatic lesion is ruled out. We report one such successful treatment with living donor LT (LDLT) after completely controlling far-advanced HCC with inferior vena cava tumor thrombosis and multiple lung metastases. The patient has been doing well without HCC recurrence for eight years since LDLT. The current patient could be an anecdotal case, but provides a case for expanding LDLT indications in the context of advanced HCC and suchlike.

Citations

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Small graft size and hepatocellular carcinoma outcomes in living donor liver transplantation: a retrospective multicentric cohort study
Deok-Gie Kim, Shin Hwang, Kwang-Woong Lee, Jong Man Kim, Young Kyoung You, Donglak Choi, Je Ho Ryu, Bong-Wan Kim, Dong-Sik Kim, Jai Young Cho, Yang Won Nah, Man ki Ju, Tae-Seok Kim, Jae Geun Lee, Myoung Soo Kim, Alessandro Parente, Ki-Hun Kim, Andrea Schl
International Journal of Surgery.2024; 110(8): 4859. CrossRef
Liver Transplant Beyond the Milan Criteria: Distant Metastases of Hepatocellular Carcinoma (Part II)
N. E. Kostrygin, D. A. Valyakis, D. S. Chumachenko, V. V. Polovinkin
Innovative Medicine of Kuban.2024; (4): 106. CrossRef
Inferior Vena Cava Thrombectomy and Stenting as Bridge to Liver Transplantation After Radiotherapy-Induced Thrombosis
Raphael PH Meier, Shani Kamberi, Josue Alvarez-Casas, Barton F. Lane, Chandra S. Bhati, Saad Malik, William Twaddell, Kirti Shetty, Adam Fang, Hyun S. Kim, Daniel G. Maluf
Progress in Transplantation.2023; 33(4): 356. CrossRef

Review Article

Liver transplantation for hepatocellular carcinoma with portal vein tumor thrombosis: Sang Jin Kim, Jong Man Kim; J Liver Cancer. 2021;21(2):105-112. Published online September 2, 2021; DOI: https://doi.org/10.17998/jlc.2021.03.17

12,181 Views
265 Downloads
3 Citations

Abstract PDF

Traditionally, liver transplantation for hepatocellular carcinoma with portal vein tumor thrombosis is not recommended. However, with recent developments in locoregional therapies for hepatocellular carcinoma, more aggressive treatments have been attempted for advanced hepatocellular carcinoma. Recently, various studies on locoregional therapies for downstaging followed by living donor liver transplantation reported inspiring overall survival and recurrence-free survival of patients. These downstaging procedures included three-dimensional conformal radiation therapy, trans-arterial chemoembolization, stereotactic body radiation therapy, trans-arterial radioembolization, hepatic arterial infusion chemotherapy and combinations of these therapies. Selection of the optimal downstaging protocol should depend on tumor location, biology and background liver status. The risk factors affecting outcome include pre-downstaging alpha-fetoprotein values, delta alpha-fetoprotein values, disappearance of portal vein tumor thrombosis on imaging and meeting the Milan criteria or not after downstaging. For hepatocellular carcinoma with portal vein tumor thrombosis, downstaging procedure with liver transplantation in mind would be helpful. If the reaction of the downstaged tumor is good, liver transplantation may be performed.

Citations

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Metastatic papillary renal cell carcinoma with portal vein tumor thrombosis confirmed on blind liver biopsy
Hun Kim, Tae Hoon Roh, Jun Seop Lee, Min Seong Kim, Beom Kyung Kim
Journal of Liver Cancer.2024; 24(1): 113. CrossRef
Refining MRI-based criteria for portal vein invasion in hepatocellular carcinoma: improving sensitivity beyond portal vein tumor thrombosis
Jeongju Kim, Woo Kyoung Jeong, Jong Man Kim, Sang Yun Ha, Kyunga Kim
Abdominal Radiology.2023; 49(2): 437. CrossRef
Prediction models of hepatocellular carcinoma recurrence after liver transplantation: A comprehensive review
Sang Jin Kim, Jong Man Kim
Clinical and Molecular Hepatology.2022; 28(4): 739. CrossRef

Case Report

Successful Sequential Therapy Involving Regorafenib after Failure of Sorafenib in a Patient with Recurrent Hepatocellular Carcinoma after Liver Transplantation: Soon Kyu Lee, Jeong Won Jang, Heechul Nam, Pil Soo Sung, Si Hyun Bae, Jong Young Choi, Seung Kew Yoon; J Liver Cancer. 2020;20(1):84-89. Published online March 31, 2020; DOI: https://doi.org/10.17998/jlc.20.1.84

5,769 Views
104 Downloads
1 Citation

Abstract PDF

The efficacy and safety of sequential systemic therapy for the treatment of recurrent hepatocellular carcinoma (HCC) after liver transplantation (LT) are not well established. This study describes a successful experience where sequential therapy with sorafenib followed by regorafenib was used to treat recurrent HCC in a 54-year old male LT recipient. After HCC recurred in both lungs 10 months after LT, sorafenib was administered with radiation therapy to treat pulmonary metastases. However, after 4 months of sorafenib treatment showed progressive pulmonary metastases, sequential regorafenib treatment was started. After 3 months (cycles) of regorafenib treatment, tumor response was partial, and after 6 months (cycles), disease status remained stable without signs of progression or drug-related serious adverse events. This case suggests that sequential systemic therapy is feasible in patient with recurrent HCC after LT.

Citations

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Liver Transplant Beyond the Milan Criteria: Distant Metastases of Hepatocellular Carcinoma (Part II)
N. E. Kostrygin, D. A. Valyakis, D. S. Chumachenko, V. V. Polovinkin
Innovative Medicine of Kuban.2024; (4): 106. CrossRef

Review Article

Liver Transplantation in Mixed Hepatocellular Carcinoma and Cholangiocarcinoma: Jong Man Kim; J Liver Cancer. 2019;19(2):85-90. Published online September 30, 2019; DOI: https://doi.org/10.17998/jlc.19.2.85

6,890 Views
113 Downloads
2 Citations

Abstract PDF

Mixed hepatocellular carcinoma and cholangiocarcinoma (HCC-CC) are rare tumors, and the risk factors associated with them are not well understood yet. Moreover, the diagnosis of mixed HCC-CC can be complicated due to the difficulty in distinguishing mixed HCC-CC from HCC and intrahepatic CCC on radiological images. Serum tumor markers are useful when the radiological images are inconclusive. It remains unclear whether the prognosis of mixed HCC-CC differs from that of HCC. However, several studies have reported that the tumor recurrence and patient survival rates of mixed HCC-CC were similar to those of HCC after liver transplantation (LT) and liver resection. In this paper, we report that LT in patients with mixed HCC-CC achieves outcomes which are similar to those seen in LT for HCC. Therefore, the diagnosis of mixed HCC-CC should not be considered as a contraindication for LT.

Citations

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Liver transplantation for combined hepatocellular carcinoma and cholangiocarcinoma: A multicenter study
Jongman Kim, Dong-Jin Joo, Shin Hwang, Jeong-Moo Lee, Je-Ho Ryu, Yang-Won Nah, Dong-Sik Kim, Doo-Jin Kim, Young-Kyoung You, Hee-Chul Yu
World Journal of Gastrointestinal Surgery.2023; 15(7): 1340. CrossRef
The Role of Immunosuppression for Recurrent Cholangiocellular Carcinoma after Liver Transplantation
Safak Gül-Klein, Paulina Schmitz, Wenzel Schöning, Robert Öllinger, Georg Lurje, Sven Jonas, Deniz Uluk, Uwe Pelzer, Frank Tacke, Moritz Schmelzle, Johann Pratschke, Ramin Raul Ossami Saidy, Dennis Eurich
Cancers.2022; 14(12): 2890. CrossRef

Case Reports

Early Onset Polymorphic Post-transplant Lymphoproliferative Disease Mimicking a Solitary Necrotizing Abscess in a Graft Liver: Pil Soo Sung, Jaejun Lee, Joon Lee, Hee Chul Nam, Si Hyun Bae, Seung Kew Yoon; J Liver Cancer. 2019;19(2):165-170. Published online September 30, 2019; DOI: https://doi.org/10.17998/jlc.19.2.165

7,805 Views
86 Downloads
1 Citation

Abstract PDF

Although post-transplantation lymphoproliferative disease (PTLD) after liver transplantation is very rare, its prognosis is worse than that of PTLD following other types of solid organ transplantation. Here, we report a rare case of early onset polymorphic PTLD in a graft liver occurring five months after deceased-donor liver transplantation due to hepatocellular carcinoma and hepatitis C virus infection. Initially, findings from contrast-enhanced magnetic resonance imaging mistakenly suspected the lesion was a necrotizing abscess with central necrosis. However, ¹⁸F-fluorodeoxyglucose positron emission tomography and biopsy findings confirmed an Epstein-Barr virus (EBV)-associated, B cell type polymorphic PTLD with central necrosis. Our case suggests regular monitoring of EBV serologic status for liver transplant recipients who were initially in an EBV seronegative state. Although early-onset PTLD is very rare after liver transplantation, PTLD should be suspected when recipients show the seroconversion for EBV proteins and the development of new tumors with various clinical presentations.

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The ‘Oma’s of the Gammas—Cancerogenesis by γ-Herpesviruses
Anwesha Banerjee, Debashree Dass, Soumik Mukherjee, Mollina Kaul, R. Harshithkumar, Parikshit Bagchi, Anupam Mukherjee
Viruses.2024; 16(12): 1928. CrossRef

A Case of Successful Living Donor Liver Transplantation after Downstaging of Hepatocellular Carcinoma with the Beyond Milan Criteria by Radioembolization, Hepatic Arterial Infusion Chemotherapy, and Stereotactic Body Radiation Therapy: Yeong Jin Kim, Yeon Seung Chung, Beom Kyung Kim, Jin Sil Sung, Do Young Kim; J Liver Cancer. 2017;17(2):182-185. Published online September 30, 2017; DOI: https://doi.org/10.17998/jlc.17.2.182

2,742 Views
20 Downloads

Abstract PDF: Liver transplantation for patients with hepatocellular carcinoma (HCC) within the Milan criteria generally yields a 4-year overall survival rate of 75% and 4-year recurrence free survival rate of 83%. But, many HCC patients present with the disease beyond the Milan criteria. On the other hands, the overall survival of patients with advanced HCC with portal vein invasion is very poor. We report a
case
of successful living donor liver transplantation for advanced HCC with portal vein invasion by down-staging through radioembolization, hepatic arterial infusion chemotherapy, and stereotactic body radiation therapy.

Review Article

Surgical Perspectives of Hepatocellular Carcinoma beyond the Barcelona Clinical Liver Cancer Guideline; Focusing on Liver Transplantation: Nam-Joon Yi, Gwang-Woong Lee, Kyoung-Suk Suh; J Liver Cancer. 2015;15(1):4-10. Published online March 31, 2015; DOI: https://doi.org/10.17998/jlc.15.1.4

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Abstract PDF: The management of hepatocellular carcinoma (HCC) is decided according to the evidence base recommendations generated by international societies especially by Barcelona clinical liver cancer (BCLC) guideline. However, the BCLC guideline based on studies of the Western countries, has not been well matched to real life cohort in Korea. In Western countries, a deceased donor liver transplantation has been well allocated to the HCC patients with preserved liver function. Patients with mild to moderate portal hypertension and certain BCLC B patients could be eligible for hepatic resection if a chance for 50% survival rate at 5 years is perceived. If liver transplantation (LT) is back up for liver resection in those patients as a salvage therapy, widening indication of liver resection could be much easily acceptable. On the other hands, new selection criteria of HCC beyond Milan criteria considering tumor biology, has been provided in the field of LT resulting in more than 50% survival rate at 5 years. Herein, surgical perspectives beyond the BCLC recommendation for LT for HCC would be reviewed in the respect of Korean surgeon’s view in this article.

Case Report

Living Donor Liver Transplantation for Hepatocellular Carcinoma with Portal Vein Tumor Thrombus: YoungRok Choi, Kwang-Woong Lee, Hae Won Lee, Nam-Joon Yi, Kyung-Suk Suh; Journal of the Korean Liver Cancer Study Group. 2013;13(1):62-64. Published online February 28, 2013; DOI: https://doi.org/10.17998/jlc.13.1.62

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Abstract PDF: Malignant portal vein thrombosis is a contraindication to liver transplantation for hepatocellular carcinoma because of the high risk of its recurrence and the poor patient survival. With a newly developed immunosuppressant and a chemotherapeutic agent, however, living donor liver transplantation can be considered for a patient of hepatocellular carcinoma, showing a slow growth rate and good response for transarterial chemoembolization. We report a HBV related liver cirrhosis patient with HCC and portal vein tumor thrombus who underwent living donor liver transplantation and survived without recurrence of hepatocellular carcinoma for 18 months in our center.

Review Articles

Strategies for the Curative Therapy of Early Stage HCC: Resection, Is It Real First Choice?: Wan-Bae Kim; Journal of the Korean Liver Cancer Study Group. 2012;12(2):97-101. Published online September 30, 2012

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Abstract PDF: Early stage HCC has generally been defined as the “Milan criteria”: a solitary tumor ≤ 5 cm in size, or ≤ 3 tumors each ≤ 3 cm in size and no evidence of gross vascular invasion. HCC is now increasingly detected at earlier stages. In addition, both liver transplantation and percutaneous ablative therapies have emerged as effective alternatives to hepatic resection. As a result, the ideal treatment strategy for patients with early stage HCC, particularly in the setting of well-preserved hepatic function, has become increasingly controversial. In the recent studies, the survival rates for transplantation in early stage HCC patients are excellent. However, when intention-to-treat analysis is used, dropouts from the waiting list due to death or disease progression clearly diminish long-term survival results and therefore patients are unlikely to benefit from liver transplantation. In addition, salvage transplantation after HCC resection may be performed without excessive morbidity and may result in equivalent survival rates compared with primary liver transplantation. In some studies, salvage transplantation may be feasible in up to 75-80% of patients with recurrence following hepatic resection. Similarly, locoregional therapies serve to sustain patients with HCC on the waiting list until a transplantation become available. While RFA and TACE are commonly used to prevent dropout, pretransplant therapy has not been associated with improved overall survival or disease-free survival due to persistenceof viable tumor. It is important to note that, while resection is a more invasive procedure, the benefit that it holds over nonresectional therapies is the complete removal of the tumor allowing for subsequent detailed pathologic examination of both the tumor and surrounding liver parenchyma. In conclusion, in patients with well-preserved hepatic function, liver resection remains the most appropriate and effective treatment.

Strategies for the Curative Therapy of Early Stage HCC: First or SalvageTransplantation?: Nam-Joon Yi; Journal of the Korean Liver Cancer Study Group. 2012;12(2):102-108. Published online September 30, 2012

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Abstract PDF: Hepatocellular carcinoma (HCC) is a major cause of cancer mortality worldwide, especially in Asian countriesas well as Korea, and liver transplantation (LT) has potentials to improve survival for patients with HCC. However, major hamper to LT for HCC has been graft shortage. To solve this problem, liver resection (LR) has to be rejuvenated in the general algorithm of HCC treatment in the light of salvage transplantation (ST) strategies. The LR followed by ST in case of HCC recurrence is an attractive concept in early stage HCC and cirrhosis with acceptable liver function. These challenges in technique, indications, pre-LT observation and treatments for recurred HCC, and prioritization policies of patients on the waiting list have to be precise through prospective investigations that have to include individualization of prognosis, biological variables and pathology surrogates as stratification criteria. Accepting this challenges have been part of the history of LT and will endure for the future. This article will focus on the ST after LR in terms of intention-to-analysis

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