Hepatocellular carcinoma (HCC) remains a common indication for liver transplantation (LT) in terms of waitlist registrants and recipients, regardless of underlying etiology. LT is one of the most effective treatments for carefully selected patients with HCC within the Milan criteria (MC) and without evidence of vascular or extrahepatic involvement. The advent of more effective systemic and loco-regional therapies has enabled patients to undergo LT who would otherwise have been considered untransplantable. This review covers the selection criteria, bridging and down-staging strategies, and recent advancements in targeted therapy, as well as how these could be integrated into managing HCC patients undergoing liver transplants.