BACKGROUND: Orthotopic liver transplantation ( OLT)has been the valuable treatment of choice for patients withhepatocellular carcinoma ( HCC). As the number of pa-tients with portal vein tumor thrombi ( PVTT) increases,most transplant centers become suspicious of the exacteffect of the operation which has been accepted as a radicalmethod. This study was designed to evaluate the clinicaleffects of OLT for patients with HCC associated withPVTT.METHODS: The follow-up of 24 patients with HCC com-plicated by PVTT who had received OLT ( transplantgroup) from January 1999 to March 2003 was compared tothat of 27 patients undergoing routine hepatic resection (re-section group) and 59 patients without surgical treatment(non-surgical group).RESULTS: The perioperative mortality was zero for thetransplant group. The 6-month, 1-year, and 2-year overallsurvival rates were 66.7%, 29.5% and 23.6% for the trans-plant group, 33.3%, 22.2% and 14.8% for the resectiongroup (P =0.0335), and 42.1%, 24.4% and 4.1% for thenon-surgical group, respectively (P =0.0316). The tumorfree survival rates of recipients at 6-month, 1-year, and 2-year were 51.5%, 23.2% and zero, respectively. Duringthe period of follow-up, the overall post-transplant intrahe-patic recurrence or extrahepatic metastasis rate was 66.7%for the transplant group.CONCLUSION: OLT is an effective but palliative treat-ment modality for patients with HCC associated withPVTT followed by a prolonged survival but a poor tumorfree survival rate. BACKGROUND: Orthotopic liver transplantation (OLT) has been the valuable treatment of choice for patients with hepatocellular carcinoma (HCC). As the number of pa-tients with portal vein tumor thrombi (PVTT) increases, most transplant centers become suspicious of the exacteffect of the The study was designed to evaluate the clinicaleffects of OLT for patients with HCC associated with PVTT. METHODS: The follow-up of 24 patients with HCC com-plicated by PVTT who had received OLT (transplantgroup) from January 1999 to March 2003 was rather tothat of 27 patients undergoing routine hepatic resection (re-section group) and 59 patients without surgical treatment (non-surgical group) .RESULTS: The perioperative mortality was zero for the transplant group. The 6-month, 1-year, and 2-year overallsurvival rates were 66.7%, 29.5% and 23.6% for the trans-plant group, 33.3%, 22.2% and 14.8% for the resection group (P = 0.0335)4.1% for thenon-surgical group, respectively (P = 0.0316). The tumorfree survival rates of recipients at 6-month, 1-year, and 2-year were 51.5%, 23.2% and zero, respectively. up, the overall post-transplant intrahepatic recurrence or extrahepatic metastasis rate was 66.7% for the transplant group. CONCLUSION: OLT is an effective but palliative treat ment modality for patients with HCC associated with PVTT followed by a prolonged survival but a poor tumor free survival rate.