Echinococcosis is caused by the tapeworm of genus Echinococcus. The two main types of these parasitic infestations include: cystic echinococcosis and alveolar echinococcosis caused by Echinococcus granulosus and Echinococcus multilocularis, respectively. The common site affected by the disease is the liver, and it usually manifest as cystic lesion that may not be symptomatic. Though the initial infection is asymptomatic, progressive enlargement of the hydatid liver cyst can manifest as abdominal pain. Treatments of hepatic echinococcosis include medical therapy or surgical therapy. Most of the cases of hepatic echinoccus can be treated with surgical drainage or resection. However, in a few group of patients with hepatic alveolar echinoccus, liver transplant may be indicated. The indications for liver transplant include advanced disease, severe liver insufficiency, recurrent life threatening cholangitis, inability to perform a radical liver resection, and absence of extrahepatic disease. Other additional indications reported include recurrent cholangitis, bleeding caused by portal hypertension, and chronic Budd–Chiari syndrome. Options for liver transplant in hepatic alveolar echinococcosis include allograft liver transplantation and ex vivo liver resection and autotransplantation. Liver transplantation is commonly performed in these patients but is limited by shortage of donors. Another limitation is the need for post-transplant immunosuppression which is associated with increased risk of recurrence. These limitations were avoided with the use of ex vivo liver resection and autotransplantation as transplant option, and it is has been shown to have equivalent outcome to allograft liver transplantation.