Conventionally, liver transplantation for hepatocellular carcinoma in the United States has been restricted to those within Milan criteria and low alpha-fetoprotein. Liver transplant may be a viable treatment option for those with larger tumors who are successfully downstaged to within Milan criteria, with demonstrated response to locoregional therapy. More liberal criteria may be associated with inferior waiting list and transplant outcomes, in terms of waiting list dropout, post-transplant HCC recurrence, and overall intent-to-treat survival. However, with careful selection practices, patients with larger tumors can do well with liver transplantation and should not be excluded a priori based on tumor size or number alone.