Key Points • Recurrent HCC after OLT management is challenging and notoriously difficult. • High oncologic-risk patient identification and close follow-up are essential. • Recurrences diagnosed within the first 2 years after OLT can be classified as early-onset and are associated with poor prognosis. • Surgical resection should be the first curative attempt when it is technically feasible. • TACE in patients who have undergone OLT appears to be effective and safe. • Sorafenib can be used as systemic therapy in cases with multi-organ recurrence; newer therapies are emerging. • The benefit of immunosuppression with an mTOR inhibitor has not been established. • In the posttransplant setting, a combination treatment approach is warranted.