*Purpose: There was no distinct guideline how to take into account the effect of pretransplant locoregional treatment (LRT) in hepatocellular carcinoma (HCC) staging system. The aim of this study was to investigate the prognosis of pathologic downstaging (PDS) by the elimination of total necrosis after liver transplantation.

*Methods: We conducted a study of 326 HCC patients underwent liver transplantation between September 2005 and December 2016.

*Results: Two hundred twenty-two patients received pretransplant LRT and 102 patients did not. Among the former group, 74 (33.0%) achieved PDS while 150 (67.0%) showed unchanged T stage after the elimination of total necrosis. Five-year HCC recurrent free survival (RFS) of PDS group (85.1%) was similar with no LRT group (88.8%) but higher than non-PDS group (68.9%; P<0.001). When compared according to the adjusted T stage and PDS status, PDS T1 (82.4%) showed similar 5 year RFS with non-PDS T1(86.5%). Non-PDS T2 cancers had worse outcome regardless of MC (P=0.982) or UCSF criteria (0.466). When preoperative examination, less than 1 viable tumor, less than 1cm of tumor size and less than 20 ng/mL of serum alpha fetoprotein were associated with PDS.

*Conclusions: Current study showed that PDS by LRT was associated with favorable outcome in HCC patients after liver transplantation.

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