Hepatocellular carcinoma (HCC) recurrence following liver transplantation (LT)—which remains the most definitive curative option for patients with cirrhosis and early-stage HCC—continues to pose a significant challenge for hepatologists and transplant surgeons. Despite the widespread use of selection criteria that now incorporate both tumor morphology and biological behavior, HCC recurrence remains a persistent issue and is a major determinant of long-term survival outcomes. The therapeutic approach to recurrent HCC after LT depends on several key factors, including the time elapsed since transplantation, the pattern of recurrence (whether isolated or disseminated), graft function, and the recipient’s overall performance status. This review outlines strategies for surveillance aimed at early detection of recurrence, assessment of tumor characteristics upon recurrence, and individualized treatment planning based on disease extent. When recurrence is confined to a single organ—either within the graft or at an extrahepatic site—curative interventions such as surgical resection or local ablation (as opposed to systemic or palliative treatment alone) are associated with improved long-term survival. Core management principles include surgery, ablation, radiotherapy, systemic therapy, and modification of immunosuppression to incorporate mTOR inhibitors. Even in the context of recurrence, an aggressive, multimodal treatment strategy—when feasible—can significantly extend survival in selected patients.