Until establishment of the Milan criteria in 1996, long-term survival in many hepatocellular carcinoma (HCC) patients receiving liver transplants was elusive, raising questions about practicality of transplantation in these patients (1). Subsequently, strict adherence to the criteria led to survival roughly equivalent to that of non-tumor patients undergoing liver transplantation, so HCC patients represented equally sound organ utilization and could be included in allocation algorithms (2). In many European studies, 5-year survival after liver transplantation for patients with HCC within Milan criteria ranged from 71％to 75％ (2-5). Unfortunately, up to 70％ of patients with HCC are diagnosed at advanced stages of disease (6), and are not suitable transplantation candidates by Milan criteria. For most of these patients, current treatment options offer little chance of cure (7,8). This had led some authors to extend transplantation to patients with tumors exceeding Milan criteria.