We report a case of hepatocellular carcinoma (HCC) recurrence after the patient received a living donor liver transplantation, which was treated by combined modality therapy. The patient survived for 67 months. A 61-year-old male was diagnosed as HCC with alcoholic cirrhosis and was transplanted the liver from a living donor. The number of tumors was about 50, the maximum tumor size was 3.3 cm and histology of the tumor was poorly differentiated hepatocellular carcinoma with portal invasion (Vp2). HCC recurred at the peritoneum 12 months after the liver transplantation and was surgically resected. Then, multiple HCC recurred in the liver graft and the patient was treated by systemic chemotherapy, and local therapy such as RFA, PEIT and TAE. Now 67 months after the transplantation, he additionally has a HCC metastasis to the spleen and lung and is treated by combined modality therapy. This case suggested that a combined modality therapy might have improved the survival of the patient after recurrence in the liver transplantation for advanced HCC.