Purpose: Liver transplantation (LT) as treatment for hepatocellular carcinoma (HCC) is known to be the best therapeutic option. To obtain good result, it is important to select appropriate LT candidates among HCC patients. Up to now, Many centers have their own criteria, which is from the influencing factors to survival. Especially in living donor liver transplantation (LDLT), it is worthwhile to investigate such various criteria whether the effect is. Methods: From October 2000 to November 2011, we retrospectively analyzed 224 patients who had undergone LDLT for HCC. To identify risk factors for recurrence, we provided our own criteria from the patient’s and tumor characteristics based on the recurrence. And then, we compared our selection criteria with various tumor grading scales, such as Milan criteria, UCSF criteria, TNM stage, BCLC stage and CLIP scoring system. The median follow-up was 68 (6∼139) months. Results: In 224 patients who received LDLT for HCC, 37 patients(16.5%) experienced tumor recurrences. The 5 year disease free survival (DFS) and overall survival rates after LDLT in all patients with HCC were 80.9% and 76.4% respectively. On multivariate analysis, the tumor diameter (5 cm)(P=<0.001, Exp(B) 11.89, 95%CI: 3.784-37.368) and alpha-fetoprotein (AFP) level (100 ng/ml) (P=0.021, Exp(B) 2.892, 95%CI: 1.172-7.132) had significant influence on HCC recurrence after LDLT and therefore, these 2 factors included our new criteria. Within our new criteria (65.4%, 140/214), 1, 3, 5 years DFS and overall survival rates were 94.0%, 89.9%, 88.6% and 91.9%, 84.0%, 81.8%. Our criteria (p<0.001), Milan criteria (p=0.009), UCSF criteria (p=0.001) in DFS and our criteria (p=0.006), UCSF criteria (p=0.009) in overall survival rate showed significant difference. Among stage 0, A, B and C of BCLC stage, only stage C had significantly higher recurrence rate (P=<0.001), lower DFS (P=<0.001) and overall survival rate (P=0.005). On the CLIP scoring system, 4 and 5 point group showed high frequency of recurrence rate (P=0.023), lower DFS (P=0.011) compare to other lower score group. Conclusion: LT is considered as the preferred therapeutic option in such patients who have AFP ≤ 100ng/mL and tumor diameter ≤ 5cm. Milan criteria, UCSF criteria, BCLC stage and CLIP scoring system are also good therapeutic guide lines. Further verification of these findings by a prospective study is required for clinical application.

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