Liver transplantation is one option of surgical treatment for cirrhotic patients with hepatocellular carcinoma, it not only treats the malignancy but also the underlying disease. After an initial period of disappointing results, mainly due to lack of adequate selection, survival nowadays is similar to that obtained by cirrhotic patients without tumor. Currently the scarcity of donors is the main limitation in the treatment of this type of patients. Increased time on the waiting list does compromise the results if they are analyzed in an intention-to-treat basis. Adjuvant therapy on the waiting list (ethanol injection, chemoembolization, surgery, etc.) or the use of marginal grafts in order to increase the donor pool may be some alternatives to overcome this deficit. The development of adult living donor liver transplantation has proved to be a good alternative in this type of patients even if they do not fulfill the conventional criteria.