Hepatocellular carcinoma, which is the fifth most common malignancy in men and the ninth most common malignancy in women worldwide, accounts for 6% of all malignant lesions. We evaluated our results for doing liver transplants in patients with hepatocellular carcinoma. Since September 2001, 238 liver transplants were performed for 234 patients at our center. Forty-two (9 female, 33 male; age range, 1 year 1 month to 65 years) of these 234 patients with preoperatively or incidentally diagnosed hepatocellular carcinoma underwent a liver transplant at our center. Twelve of the grafts were from deceased donors, and 30 were from living-related donors. Inclusion criteria (independent of tumor size and number of tumor) were no invasion of a major vascular structure and no evidence of extrahepatic disease. In 24 of the patients, the tumors exceeded Milan criteria. According to the Tumor-Nodes-Metastasis staging system, 7 patients had stage-I, 11 had stage-II, 3 had stage-III, and 21 had stage-IVA1 carcinomas. At the time of this writing, at a mean follow-up of 27.6 ± 17.3 months (range, 2-55 months), 36 patients are well with excellent graft functioning. The longest graft survival in the study subjects is 55 months. There have been 6 tumor recurrences occurring at 3, 4, 5, 24, 26, and 29 months after liver transplant; 3 of these 6 patients are alive with good functioning grafts; the remaining 3 patients died 4, 11, and 19 months after recurrence. Three patients died 1, 1, 22 months after the liver transplant with no evidence of recurrence. In conclusion, when there is no effective treatment alternative other than liver transplant, the procedure may provide long-term disease-free survival for hepatocellular carcinoma patients even with locally advanced tumors. The option of a living-related liver transplant should be given to hopeless patients and their families.