Abstract： Objective To explore the indications and clinical value of orthotropic liver transplantation(OLT)in patients with advanced hepatic alveolar echinococcosis (HAE) .Methods The clinical data of 12 patients with advanced HAE who received OLT from January 2001 to December 2017 were retrospectively analyzed .Among them ,there were 7 males and 5 females ,the age ranged from 16～58 years(median 42 years) .The preoperative hepatic functions of 12 patients were 2 Child-Pugh class A ,3 class B and 7 class C ,and the median model for end-stage liver disease(MELD)score was 19 .5(8～23) .Results The mean time of OLT procedure and anhepatic phase in 12 patients were 456 .25(456 .25 ± 44 .98)min and 79 .17(79 .17 ± 10 .01)min respectively .The median intraoperative blood loss and hospital stay times were 1000 ml(600～4000 ml) ,and 29 .5(15 ± 58)days respectively . All the patients were followed-up for 0 months to 207 months .Among the 12 patients who underwent OLT ,2 recipients died of incurable infection of pulmonary infection on day 23 post-OLT ,and multiple organ failure on day 32 post-OLT ,respectively .One case developed lung metastasis 2 years after operation ,and brain metastasis was found in the same patient after 4 years .The recurrence occurred 3 years after OLT in another patient ,no evidence of HAE recurrence or extrahepatic metastasis was found in the remaining 8 patients .Conclusions OLT can provide patients with advanced HAE the best chance for long term disease-free and overall survival who lost the opportunity for radical hepatectomy .