Introduction: Living donor liver transplantation (LDLT) can provide life-saving therapy for many patients 
with hepatocellular carcinoma (HCC), who otherwise would succumb due to tumor progression. Offering 
LDLT to patients with HCC, however, raises complex issues for the donor, the recipient, and the medical 
team. 
Methods: The records of patients with HCC among the 150 recipients who underwent LDLT at National Liver 
Institute (NLI), Menoufiya University, Egypt, from April 2003 to October 2011, were retrospectively revised. 
The aim was to answer several questions: Should we expand the criteria for liver transplantation for HCC? 
What is the response to loco-regional therapy and role of tumor down-staging? What are the difficulties of 
evaluation? Is there especial technique considerations? What about the outcome and recurrence?
Results: HCC was the indication of LDLT in 35 (23.3%) of cases. Of these 35 HCC cases, 28 (80 %) cases were 
within Milan criteria, 4 (11.4%) cases had benign portal vein thrombosis (PVT). positron emission tomography 
(PET) was performed two weeks before LDLT to exclude distant HCC metastases. Exploration-first and 
Portahepatis-first were the used techniques. Three (8.5%) cases had recurrent HCC
Conclusion: Milan criteria remain a valid tool to select candidates for LDLT to achieve optimal results but 
expanding the criteria give chance to more patients with comparable outcome. Alfa-fetoprotein (AFP) of 
>1000 ng/mL should be considered an exclusion criterion for liver transplantation. PET scan might be of 
particular value in excluding extrahepatic HCC extension. Benign PVT does not contraindicate LT for HCC 
patients. Exploration-first and Portahepatis-first techniques are recommended in HCC cases.