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We are grateful to Dr. Tanaka (1) and Dr. Kays and his group (2) for their thoughtful comments and questions with respect to our study (3). We agree that patient selection is paramount and differences in patients with hepatocellular carcinoma (HCC) who are beyond Milan criteria and who are selected for either liver resection or transplantation are important to understand. Undoubtedly, there are patients in this category who are not candidates for transplantation. These patients usually have one or more of the following characteristics: advanced age, significant cardiovascular comorbidities, poor socioeconomic infrastructure, active mental illness, or characteristics of aggressive tumor biology. Importantly, there are also significant differences in regional, national, and continental resources directly affecting liver donor availability and use. Conversely, there are patients who are not candidates for resection due clinically significant cirrhosis (with either MELD or CPT beyond cut-off criteria), or clinically significant portal hypertension, or multifocal bi-lobar tumors, or technical limitations of operative techniques. And, of course, majority of patients with HCC beyond Milan criteria are not candidates for either resection or transplantation. To equate all these patients into one group is not possible. Patients with HCC benefit from multi-disciplinary collaboration to select best treatment for each patient.