Hepatic alveolar echinococcosis is an infectious disease caused by the larval stage of Echinococcus multilocularis. E. multilocularis grows primarily in the liver of an infected person and develops as a tumorlike lesion. In advanced cases, the organisms infiltrate every organ neighboring the liver and spread hematogenously to distant organs such as lungs and brain. Surgical resection and liver transplant are accepted treatment options for early-stage and advanced disease respectively. In this article, we present 2 patients with an advanced stage of alveolar echinococcal disease invading both lobes of the liver and neighboring vital structures including the inferior vena cava. Despite the technical difficulty of the surgery, both patients were successfully treated with a living-donor liver transplant. In conclusion, liver transplant should be accepted as a life saving treatment of choice for patients with alveolar echinococcosis whom had lost the chance of medical or surgical treatments.