BACKGROUND: Hepatocellular carcinoma (HCC) ranks as the sixth most common cancer and the third- leading cause of cancer-related deaths worldwide. The multidisciplinary tumor board (MDTB) has been recognized for improving outcomes in cancer management, but its role in patients with HCC undergoing liver transplantation (LT) remains underexplored. AIM: To evaluate the impact of an MDTB on survival outcomes in patients with HCC undergoing LT. METHODS: We retrospectively analyzed 393 patients with HCC who underwent LT at our institution from October 2015 to October 2021. Patients were categorized into the MDTB and non-MDTB groups. We compared preoperative and postoperative characteristics, overall survival (OS), and disease-free survival (DFS) between the two groups. RESULTS: Within the University of California, San Francisco (UCSF) criteria, no significant differences in OS and DFS were noted between the MDTB and non-MDTB groups. However, for patients who exceeded the UCSF criteria, the MDTB group exhibited a substantial improvement in both OS and DFS. The 1-year, 3-year, and 5-year OS rates for the MDTB group in this subgroup were 88.68%, 75.29%, and 61.78%, respectively, compared to 83.02%, 64.07%, and 38.25%, respectively in the non-MDTB group. Similarly, DFS rates were 89.47%, 71.35%, and 63.52%, respectively, 82.18%, 53.78%, and 34.04%, respectively. CONCLUSION: The MDTB approach was particularly beneficial for patients with HCC exceeding the UCSF criteria, significantly improving OS and DFS. These findings advocate for integrating MDTB into clinical practice for optimizing the management of high-risk patients with HCC undergoing LT.