Liver transplantation is recognized worldwide as one of the effective treatments for end-stage liver disease. At present, liver transplantation has been widely carried out nationwide, and there is an urgent need for relevant clinical practice guidelines to guide liver transplantation in a more standardized, effective and safe manner. The Chinese Society of Organ Transplantation, the Transplantation Group of the Chinese Society of Surgery and the Organ Transplantation Physicians Branch of the Chinese Medical Association have organized experts to formulate the Clinical Practice Guidelines for Liver Transplantation for Liver Cancer in China (2014 Edition), focusing on five parts: liver transplantation recipient selection criteria, preoperative descending treatment, recipient antiviral treatment, recipient immunosuppressive application, and prevention and treatment of tumor recurrence after surgery. The Milan standard is the reference benchmark for liver cancer liver transplant recipient selection, while the Hangzhou standard is a great breakthrough from the Milan standard which is limited to tumor morphology. Pre-operative tumor downstaging treatment for liver cancer liver transplantation can enable patients who do not meet the liver cancer liver transplant recipient selection criteria to be included in the transplantation criteria and receive a liver transplantation opportunity. Antiviral therapy for liver cancer liver transplant recipients with viral hepatitis B can help reduce the recurrence rate of viral hepatitis B after transplantation and improve the long-term survival rate of recipients. Individualized low-dose immunosuppressive regimens are currently advocated to maximize the protection of transplanted liver function while reducing its toxic side effects and recurrence of liver cancer after transplantation. The prevention and treatment of liver cancer recurrence after liver transplantation can be individualized for the recipient by using surgery, TACE, local ablation, as well as radioimmunotherapy, targeted therapy, and systemic chemotherapy. According to statistics, more than 300,000 people die from hepatocellular carcinoma (hereafter referred to as liver cancer) in China every year, accounting for about half of the global liver cancer deaths. Liver transplantation is recognized worldwide as one of the effective means of treating end-stage liver disease. Since the 2nd liver transplantation boom in China in the 1990s, liver transplantation has been developing rapidly, with specialization and scale development, and the quantity and quality of transplantation has approached or reached the level of western developed countries. As of April 2014, 26,751 liver transplants were registered on the Chinese Liver Transplant Registry website. At present, liver transplantation has been widely carried out nationwide, and there is an urgent need for relevant clinical practice guidelines to guide the national liver transplantation work in a more standardized, safe and effective manner. The Chinese Society of Organ Transplantation, the Transplantation Group of the Chinese Society of Surgery and the Organ Transplantation Physicians Branch of the Chinese Medical Association have organized experts to develop the “Clinical Practice Guidelines for Liver Transplantation for Liver Cancer in China (2014 Edition)” (hereinafter referred to as “Guidelines”), which focus on liver transplantation recipient selection criteria, preoperative descending treatment, recipient The Guidelines focus on five parts: selection criteria for liver transplant recipients, preoperative step-down therapy, antiviral therapy for recipients, application of immunosuppressive agents for recipients, and prevention and treatment of tumor recurrence after surgery. 1. Evidence-based medical evidence The evidence-based medical evidence grading adopted in this guideline mainly refers to the 2001 Oxford University Evidence-based Medical Center evidence grading standard (Table 1), and the strength of recommendation mainly refers to the GRADE system recommendation grading, etc. 2. Criteria for selecting liver transplant recipients for liver cancer The shortage of liver donor is a worldwide problem, so the valuable liver donor resources should be allocated to the largest beneficiaries of liver transplantation. Cardiac deceased organ donation is the main direction to expand the source of liver donor in China, and living liver transplantation has become a mature technique in medical units with extensive transplantation experience [3]. in 1996, after Mazzaferro et al. proposed the Milan criteria, liver transplant recipients with liver cancer meeting the Milan criteria achieved long-term survival [4-7]. However, the Milan criteria were too strict in limiting the size and number of liver cancers, and more importantly, they ignored the biological characteristics of the tumors. If based on the Milan criteria, most Chinese liver cancer patients would be deprived of liver transplantation opportunities. In recent years, some new liver cancer liver transplant recipient selection criteria have emerged internationally, such as the University of California, San Francisco (UCSF) criteria and the Up-to-Seven criteria, which were proposed with the common goal of expanding the recipient population and achieving transplant survival rates similar to the Milan criteria. In 2008, the Hangzhou criteria proposed by China were the first international liver transplantation criteria to introduce biological characteristics and pathological features of tumors, which was a great breakthrough from the previous criteria limited to tumor morphology. The results of the study confirmed that liver transplant recipients who met the Hangzhou criteria achieved satisfactory postoperative survival rates for both cadaveric and living liver transplantation [10-15]. In recent years, for those who recur after liver cancer resection, most experts advocate salvage liver transplantation if they meet the admission criteria for liver transplantation; for those with graft loss after liver cancer liver transplantation, another liver transplantation should be carefully considered [16-17]. 3. preoperative step-down therapy for liver cancer liver transplantation Preoperative tumor step-down therapy for liver cancer liver transplantation is to reduce the tumor load and stage through a series of therapies, so that patients who do not meet the selection criteria for liver cancer liver transplantation can be included in the transplantation criteria and have access to liver transplantation. Stage-reduction therapy is mainly applied to patients with liver cancer who do not meet the existing criteria for liver transplantation and do not have large vessel invasion such as portal trunk or inferior vena cava and no distant metastasis [18-21]. The main methods of descending treatment are local ablation therapy and TACE. Local ablative therapy includes RFA, microwave ablation, cryoablation and percutaneous anhydrous ethanol injection. The efficacy of degenerative therapy is evaluated by enhanced CT and MRI combined with AFP, and the evaluation indexes include tumor size, number and AFP level. The results of some studies have shown that the combination of multiple treatment methods can achieve a better outcome. 4.Anti-viral therapy for liver transplant recipients with liver cancer More than 90% of liver transplant recipients with liver cancer in China are associated with HBV infection. Recipients with high HBV load before liver transplantation and recurrence of viral hepatitis B (hereafter referred to as hepatitis B) after liver transplantation are at increased risk of liver cancer recurrence. Potent, highly resistant barrier nucleoside analogues (NAS) such as entecavir should be used in patients awaiting liver transplantation with high HBV load. Hepatitis Bimmunoglobulin (HBIG) should be given during the hepatitis-free phase of liver transplantation. The main antiviral regimen after liver transplantation is NAS combined with low-dose HBIG, with the combination of entecavir or tenofovir better preventing hepatitis B relapse after transplantation. The use of hormone-free immunosuppressive regimens may reduce the rate of hepatitis B recurrence after transplantation. Postoperative hepatitis B vaccination has also been reported in liver transplant patients to prevent hepatitis B recurrence, but its clinical application is controversial. In China, there is an increasing trend of HCV infected patients. For patients with HCV RNA positive liver function Child-Pugh score ≤7, preoperative antiviral therapy is recommended, and post-transplantation anti-HCV therapy should be given only after the recurrence of viral hepatitis C is confirmed by pathological examination. 5. Immunosuppressant application in liver transplant recipients with liver cancer The application of calcineurin inhibitor (CNI) is an independent risk factor for recurrence of liver cancer after liver transplantation [44]. In liver cancer liver transplant recipients, the risk of tumor recurrence is related to its aggressiveness and the immune function of the organism; the immune surveillance system of the recipient is disrupted when he/she is in a strong immunosuppressive state, promoting tumor recurrence and metastasis, while insufficient doses of immunosuppression tend to induce rejection. How to maintain this balance is still inconclusive. Full withdrawal of immunosuppression is not yet recommended for liver transplant recipients with hepatocellular carcinoma, but individualized low-dose immunosuppression regimens are advocated. In recent years, there are successful clinical regimens of early glucocorticoid withdrawal, glucocorticoid-free and the use of mTOR inhibitors with tumor suppressive effects (represented by sirolimus). The main immunosuppressive regimens in clinical practice are: (1) tacrolimus or cyclosporine + morte-macrolimus + glucocorticoids; (2) IL-2 receptor blocker + sirolimus + morte-macrolimus + glucocorticoids; (3) IL-2 receptor blocker + morte-macrolimus + tacrolimus / sirolimus. 6. Prevention and treatment of tumor recurrence after liver transplantation for hepatocellular carcinoma The recurrence rate of hepatocellular carcinoma 5 years after liver transplantation can be 20.0%~57.8%, so the prevention and treatment of recurrence and metastasis is very important. Morphological characteristics (size, number, etc.), stage, histological grading and biological characteristics of liver cancer should be used as important reference for postoperative drug use and individualized treatment plan. Since immune escape against tumor may exist after liver transplantation for hepatocellular carcinoma, a certain course of postoperative treatment should be given to the recipient in order to minimize micro-metastases and reduce the postoperative recurrence rate. Elective radioimmunotherapy with iodine 131 methotrexate, sorafenib therapy, and systemic chemotherapy (e.g., oxaliplatin or adriamycin in combination with fluorouracil, respectively) may provide some survival benefit for some recipients. For recurrent hepatocellular carcinoma metastases after liver transplantation, the application of sorafenib treatment may prolong the survival time of the recipient [18, 60-62]. Surgical resection of pulmonary metastases is preferred if they are resectable. Local treatment of recurrent lesions in the transplanted liver includes surgical resection, TACE, and local ablation. Some experts have suggested radiotherapy and re-liver transplantation as treatment options. For patients with advanced disease, reduction or discontinuation of immunosuppressive drugs may be considered.