Liver transplantation (LT) is a curative modality for hepatocellular carcinoma (HCC) especially in patients with cirrhosis. However, there are still risks of recurrences. C-reactive protein (CRP), an acute-phase inflammatory reactant which is synthesized by hepatocytes, has been related to prognosis in various malignancies, including HCC. In this study, we investigated a role of high CRP level in predicting post-transplant outcomes of HCC. From August 2000 to July 2010, 85 patients who had available pre-transplant serum CRP levels were analyzed. Only 2 patients received diseased donor LT, and the remaining patients received living donor LT. Using 1 mg/dL as a cut-off value, 27 patients showed high CRP levels (ó1 mg/dL), and 58 showed low CRP levels (<1 mg/dL) when received LT. Total bilirubin, Child-Pugh grade, model for end-stage liver disease score, maximal tumor size and the frequency of intrahepatic metastasis were significantly higher in the high CRP group. In multivariate analyses, HCC over the Milan criteria, high CRP level and microvascular invasion were related to tumor recurrence, and high CRP level and microvascular invasion were related to poor overall survival. When subgroup analysis was done according to the Milan criteria, the high CRP level was an independent factor to predict poor outcomes in patients with HCC over the Milan criteria (P = 0.015 for recurrence, P <0.001 for survival), while not for patients under the criteria. Serum CRP would be considered as a useful and cost-effective biomarker to predict outcomes after LT for HCC, particularly in patients over the Milan criteria. © 2012 American Association for the Study of Liver Diseases.