Abstract: Objective: : To explore the clinical and pathological factors associated with hepatocellular carcinoma(HCC) recurrence and metastasis after liver transplantation. Methods : The clinical records and tumor-free survival data of 781 patients with HCC who underwent primary liver transplantation from January 2002 to June2006 were retrospectively analyzed. Clinical and pathological risk factors associated with HCC recurrenceand metastasis were evaluated by univariate and Cox multivariate analysis. Results : The 6-month, 1-, 2- and3-year tumor-free survival rates were 86.85%, 74.87%, 63.36%, and 56.67%, respectively. After recurrence ormetastasis of HCC, the 1-year survival rate was 26.27%. Multivariate analysis using Cox proportional hazardsregression model demonstrated the diameter of the largest tumor, tumor number, bilobular distribution, vascular invasion and pretransplant alpha fetal protein level to be independent factors associated with recurrence ormetastasis of HCC. Conclusion : Strict selection of recipients can effectively prevent the recurrence and metastasis of HCC.