Hepatocellular adenoma (HCA) is a rare benign liver tumor in the pediatric population, often associated with underlying genetic syndromes or metabolic disorders. In prepubertal children, the most common subtypes are β-catenin–mutated HCA and HNF1α-inactivated HCA (H-HCA), each with distinct clinical and prognostic implications. Differentiating HCA from malignant lesions such as hepatocellular carcinoma (HCC) is critical for appropriate management. We report a 2-year-old girl with hepatic failure, who was found to have multiple hepatic nodules. Imaging studies suggested features highly indicative of HCC. Due to multiple suspicious lesions and severe liver dysfunction, liver transplantation (LT) was performed. Histopathological examination confirmed the lesions as H-HCAs. The patient was postoperatively diagnosed with hereditary tyrosinemia type 1. This case highlights the importance of including HCA in the differential diagnosis of hepatic nodules in children with metabolic disorders. Accurate diagnosis of HCA is essential to guide clinical decision-making, optimize treatment strategies including LT.

Liver transplantation (LT) is a curative therapy for selected patients with hepatocellular carcinoma (HCC) and cirrhosis, simultaneously treating tumors and underlying liver disease. This review provides an up-to-date overview of LT for HCC, focusing on key considerations for hepatobiliary surgeons. We discuss established selection criteria (Milan and University of California, San Francisco) and the evolution of expanded eligibility models incorporating tumor biology (e.g., “up-to-7” criteria, alpha-fetoprotein–based models). Outcomes of LT for HCC are excellent in appropriately selected patients, with 5-year survival >70% and low recurrence rates when within criteria. We examine strategies for downstaging advanced HCC to transplantable disease, which have enabled curative LT in patients initially beyond criteria with acceptable 10-year outcomes. We compare living donor and deceased donor LT, highlighting the role of living donor transplantation in expanding access and its comparable survival. Immunosuppression protocols are reviewed, with an emphasis on striking a balance between preventing rejection and minimizing the risk of tumor recurrence. We also address global trends and challenges, including organ shortages and ethical considerations, and survey recent innovations from clinical trials and translational research—such as machine perfusion organ preservation, novel biomarkers, and immunotherapy—for their potential impact on HCC transplant practice.