Background: Liver transplantation offers a conclusive solution for individuals diagnosed with Hepatocellular carcinoma (HCC). Alterations in alpha-fetoprotein (AFP) levels prior to transplantation could serve as an indicator for the potential recurrence of HCC. Objective: This study aimed to evaluate the capacity of variations in the pre-transplant AFP levels as a prognostic indicator for tumor recurrence after transplant. Patients and methods: 144 HCC patients had liver transplant over a 20-year period at our institute. Their mean age at time of transplant was 54.8 years, and 124 patients were males. 71 patients (49.3%) received interventions for HCC (group 1), while 73 patients (50.7%) had no HCC treatment (group 2). Results: The recurrence-free survival rate was 86.8%. HCC recurrence was reported in 19 patients (13.2%), including 17 males and 2 females. Among these 19 patients, 11 were in group 1 (15.5%), and 8 were in group 2 (11%). The predictors of recurrence were a tumor volume greater than 115 cc (P = 0.010), and AFP > 400 ng/ml (P = 0.009). While AFP gradient (AFP-G) did not exhibit a significant correlation with tumor recurrence in the entire cohort, it demonstrated a notable correlation with recurrence in untreated patients. A specific AFP-G threshold of 60 ng/ml/month was chosen. An AFP-G of 60 ng/ml/month displayed a sensitivity of 83.3% and a specificity of 94.7% for predicting HCC recurrence. Conclusion: It was noted that using an AFP-G exceeding 60 ng/ml/month should be regarded as a prognostic tool rather than a strict selection criterion for transplant candidates.