Liver transplantation (LT) is critical for selected patients with primary liver cancers, with evolving strategies improving eligibility and outcomes through personalized treatment plans.

• Patient selection now involves a “window of eligibility” that assesses overall survival rather than just technical feasibility.
• Neoadjuvant therapies, including bridging and downstaging, expand transplant eligibility for patients with advanced tumors.
• Emerging biomarkers, such as circulating tumor DNA, could enhance candidate selection and early detection of recurrence.

Surgeons should consider these new strategies to refine patient selection and improve post-transplant management, ultimately aiming for better outcomes in liver cancer treatment.