Living related liver transplantation (LRLT) for hepatocellular carcinoma (HCC) in cirrhotic patients has emerged as a rewarding therapy aiming at cure. Extension of the Milan criteria has been proposed with encouraging results. From October 2001 to June 2004, 47 adult patients with end stage liver disease have been treated by LRLT. Eleven of these patients, nine males and two females, had HCC on top of HCV related (n=10) and HBV related (n=1), cirrhosis. Their mean age was 50 years (range: 40-61). HCC was confirmed in nine patients preoperatively while it was an incidental finding in two cases. AFP levels were elevated in five of the 11 patients. Radiologically, the tumor number and sizes ranged from 1-2 nodules and from 1.5 to 7 cm, respectively. Five of the 11 patients received pre-transplant tumor control therapy. Nine patients are alive, all of them being disease free during a follow-up period ranging from 2 to 30 month. Two patients died, one from HCC recurrence at 1 year posttransplant and another due to pulmonary embolism on D7. AFP levels dropped to normal values in 4 cases. Excluding the 2 incidental tumors, pathological examination of the explants revealed a higher number and larger sizes of the nodules in 3 and 5 cases, respectively. Microvascular invasion was documented in 3 explants, one of them had HCC recurrence and the other 2 cases received 6 cycles of Doxorubicin following normalization of their liver profile. Postoperative complications included; recurrent HCC (n=1), recurrent HCV graft affection (n=2), acute cellular rejection (n=3), anastomotic biliary stricture (n=1) and subphrenic collection (n=1). Our current data confirms the efficacy of LRLT in treatment of HCC on top of liver cirrhosis.