Objective:We aimed to evaluate the efficacy and safety of steroid-free immunosuppression after liver transplantation(LT)for hepatocellular carcinoma(HCC).Methods:We retrospectively analyzed HCC recipients without steroids after LT(SF group,n=368)based on the China Liver Transplant Registry(CLTR)database.These recipients were matched 1:2 with patients using steroids(S group,n=736)for the same period after LT for HCC,according to propensity scores.Results:Multivariate analysis indicates that recipients with younger age[odds ratio(OR),1.053;P=0.011],preoperative hepatitis B virus(HBV)DNA≥1,000 copies/mL(OR,2.597;P=0.004)and beyond Milan criteria(OR,4.255;P<0.001)were identified as the risk factors associated with tumor recurrence in steroid avoidance recipients after LT.The patients fulfilling the Milan criteria in the SF group presented higher overall and tumor-free survival rates than those in the S group(P<0.05).Multivariate analysis revealed that recipient beyond Milan criteria was an independent prognostic factor for overall survival(OR,1.690;P<0.001)and tumor-free survival(OR,2.066;P<0.001).The incidences of new-onset diabetes mellitus(21.20% vs.33.29%,P<0.001),new-onset hypertension(10.05%vs.18.61%,P<0.001)and hyperlipidemia(4.08% vs.7.20%,P=0.042)were significantly lower in the SF group.Conclusions:Steroid-free immunosuppression could be safe and feasible for HBV-related HCC patients in LT.Age,HBV DNA level and Milan criteria maybe risk factors associated with tumor recurrence in steroid avoidance recipients.Recipient beyond Milan criteria was an independent prognostic factor and recipient fulfilling Milan criteria can benefit the most from steroid-free immunosuppression. Objective: We aimed to evaluate the efficacy and safety of steroid-free immunosuppression after liver transplantation (LT) for hepatocellular carcinoma (HCC). Methods: We retrospectively analyzed HCC recipients without steroids after LT (SF group, n = 368) based on the China Liver Transplant Registry (CLTR) database.These recipients were matched 1: 2 with patients using steroids (S group, n = 736) for the same period after LT for HCC, according to propensity scores. Results: Multivariate analysis indicates that recipients with (OR, 2.597; P = 0.004) and beyond Milan criteria (OR, 4.255; P <0.001, P <0.001) ) Identified as the risk factors associated with tumor recurrence in steroid avoidance recipients after LT. These patients fulfilling the Milan criteria in the SF group presented higher overall and tumor-free survival rates than those in the S group (P <0.05) .Multivariate analysis revealed that recipient beyond Milan criteria was an independent prognostic factor for overall survival (OR, 1.690; P <0.001) and tumor-free survival (OR, 2.066; P <0.001) .The incidences of new- onset diabetes mellitus (21.20% vs.33.29% ), new-onset hypertension (10.05% vs.18.61%, P <0.001) and hyperlipidemia (4.08% vs.7.20%, P = 0.042) were significantly lower in the SF group.Conclusions: Steroid-free immunosuppression could be be safe and feasible for HBV-related HCC patients in LT. Age, HBV DNA level and Milan criteria maybe risk factors associated with tumor recurrence in steroid avoidance recipients. Recipient beyond Milan criteria was an independent prognostic factor and recipient fulfilling Milan criteria can benefit the most from steroid -free immunosuppression.