Immunosuppressive medications inhibit the "tumor surveillance" properties of the immune system. Consequently, immunosuppression may increase the likelihood of hepatocellular carcinoma (HCC) recurrence after liver transplantation. However, most of the data on the effect of immunosuppression on HCC recurrence is derived from experimental (in vitro and animal) studies as well as single-center, non-randomized reports. There are no published randomized trials evaluating any immunosuppressive agent(s) on HCC recurrence after liver transplantation. Therefore, the precise effects of immunosuppression on HCC recurrence in liver transplant recipients are difficult to assess.