Hepatocellular carcinoma (HCC) is a common indication for liver transplantation (LT). Currently, deceased donor LT is approved by the United Network for Organ Sharing for patients with HCC who meet the Milan criteria of a single tumor up to 5 cm or up to 3 tumors up to 3 cm as determined by imaging studies. We analyzed data in the International Registry of Hepatic Tumors in Liver Transplantation from 1,206 patients with HCC. Tumor size and number were determined by gross pathologic examination. Kaplan-Meier recurrence-free survival in patients with a single tumor ≤5 cm or 2-3 lesions all ≤3 cm in diameter was 84.7% at 1 year and 61.8% at 5 years. Overall, patients whose tumor or tumors exceeded these limits had worse survival (67.2% at 1 year and 42.8% at 5 years, P < 0.001); however, not all patients in this group did poorly. Patients with 2-4 tumors ≤5 cm or single lesions ≤6 cm had recurrence-free survival equivalent to patients with a single tumor of 3.1-5.0 cm or 2-3 lesions all ≤3 cm in diameter. These data suggest that current criteria for selecting tumor patients for LT may be too restrictive and could be expanded. Liver Transpl 13:391–399, 2007. © 2007 AASLD.