The state of the art in liver transplantation for hepatocellular carcinoma is presented through a review of our own data and the pertinent literature. Preoperative evaluation should stage the tumor precisely to allow therapeutic consequences to be drawn. The major obstacle is correct preoperative lymph node staging which is currently possible in less than 50% of the patients. If candidates are selected for transplantation, early vascular exclusion should be performed during the operation to prevent tumor cell dissemination. The results of recent reports on liver transplantation for hepatocellular carcinoma following strict selection criteria are encouraging. Patients with cirrhosis and hepatocellular carcinoma (diameter < 10 cm) fared significantly better after liver transplantation than after resection. Patients with uninodular or binodular disease and tumors smaller than 3 cm even showed a recurrence-free 3 year survival of 83% [3]. We conclude that for some patients liver transplantation offers the only chance for cure. Only prospective, controlled trials will define the patients that profit most from liver transplantation. The rising need for donor organs will currently restrict this modality to a highly selected group of patients. Once effective adjuvant therapies become available more patients might, however, become eligible.