Liver transplantation has a definitive place in the treatment of patients with hepatocellular carcinoma (HCC) in a cirrhotic liver. Patients with a tumor load within the Milan criteria have excellent survival comparable to survival in patients with benign indications. When tumor load exceeds the Milan criteria survival decreases. Staging of patients with HCC in a cirrhotic liver is deficient due to the restrictions of the current imaging modalities. The exact place of tumor controlling therapies during the waiting time for transplantation is not yet clear. No evidence of sufficient level is available as to the efficacy of pre-, per- or postoperative chemotherapy. Promising new drugs are currently tested. This counts also for the use of new immunosuppressant with concomitant tumor suppressive capabilities.