1.1 Indications: post-necrotizing cirrhosis, biliary cirrhosis, cirrhosis, cholangitis, primary liver cancer, primary bile duct cancer, fulminant liver failure, Budd Chiari syndrome, biliary atresia, inborn metabolic disease, familial biliary stagnation, inborn fibrous disease. 1.2 Indications for Liver Transplantation Liver transplantation is indicated for the following liver diseases: (1) End-stage progressive liver disease for which there is no other effective treatment. (2) Certain primary hepatobiliary tumors for which liver transplantation is the only possible cure. (3) When there is no hepatic failure, but there is a history of recurrent gastrointestinal hemorrhage due to rupture of the esophageal varices, and the quality of life is so poor that liver transplantation is the only way to improve the preexisting condition. (4) Some metabolic diseases of the liver require treatment by liver transplantation even if liver function is normal. 1.3 Re-conceptualization of the indications and indications for liver transplantation 1.3.1 Confined malignant tumors in the liver: In principle, this is a contraindication because the cancer will recur very quickly after transplantation. However, in view of the extremely low rate of partial hepatectomy (5%-15%) and high recurrence rate (50%-70%) of hepatocellular carcinoma, total hepatectomy and liver transplantation is a rational choice. Moreover, there are many cases of long-term survival among patients who underwent liver transplantation for malignant tumors. Overall, patients with primary liver malignancies may have very good immediate results after transplantation, but poor long-term results. The vast majority of centers have performed liver transplantation for liver malignancies. The malignant tumors with better survival outcomes after transplantation include: ① centrally located small hepatocellular carcinomas (≤3.0 cm in diameter), especially those combined with cirrhosis ② primary hepatocellular carcinomas with low malignancy ③ AFP-negative hepatocellular carcinomas ④ fibrous platelike carcinomas ⑤ fibrochondromas of the liver ⑥ hemangioendothelial sarcomas ⑦ embryonal cell tumors ⑧ cholangiocarcinomas of the hepatic hilar region, and so on. At present, the improvement of surgical techniques and intensive care have greatly reduced the postoperative mortality of liver transplantation, and the postoperative mortality of liver transplantation in many transplantation centers has been reduced to 0-3%, while the mortality rate of HCC combined with cirrhosis after partial hepatectomy is still 3%-15%. In 1996, Klintmalm counted 394 cases of fibroplaque hepatocellular carcinoma in 40 centers of 8 countries in the 16th International Conference on Transplantation, and the survival rates of 1, 2, and 5 years after liver transplantation reached 90%, 90%, and 70% respectively, and the survival rates of other types of hepatocellular carcinoma also reached 69%, 61%, and 41%. A small number of patients with liver metastases from gastric cancer and pancreatic islet alpha-cell tumors had very good survival outcomes after liver transplantation. Liver transplantation is an effective treatment for patients with hepatic malignancies without extrahepatic metastases compared to conventional hepatectomy for liver tumors. The efficacy of liver transplantation in the treatment of hepatic malignancies is equal to or better than that of hepatic resection in patients with concomitant cirrhosis. Because, total liver transplantation offers the possibility of complete removal of intrahepatic lesions. In contrast, regular or irregular hepatic resection is often unable to achieve sufficiently clean margins due to the limitation of liver reserve capacity, not to mention that a significant proportion of patients with hepatocellular carcinoma have multiple cancerous nodules or satellite nodules at the same time, which may be missed during resection. Moreover, only liver transplantation can completely eliminate pre-existing liver lesions such as cirrhosis, primary sclerosing cholangitis, etc., and prevent new tumor foci from arising on the basis of pre-existing liver lesions. Whole liver transplantation also reduces postoperative mortality due to complications of cirrhosis. For HCC with single tumor <5cm, multiple tumors <3cm, and the number of nodules <2~3, combined with cirrhosis, fibroplaque hepatocellular carcinoma, "accidental" carcinoma, etc., liver transplantation can achieve very good therapeutic effect and even long-term tumor-free survival. Radical resection is preferred for cholangiocarcinoma. For those who cannot undergo radical resection, even with severe cirrhosis or limited intrahepatic recurrence after the first radical resection, liver transplantation can be considered as long as there is no extrahepatic metastasis with UICC stage II. Metastatic hepatocellular carcinoma: For some metastatic hepatocellular carcinoma with slow growth and metastasis confined to the liver, resection of the primary focus and liver transplantation can achieve a high 5-year survival rate and tumor-free survival. For progressive hepatic malignant tumors (stages III and IV), especially with the presence of huge liver and jaundice, liver transplantation, as a palliative means, can effectively improve the quality of survival. As with surgical treatment of other liver tumors, chemotherapy should be scheduled at the appropriate time after liver transplantation in patients with hepatocellular carcinoma.