Objective: Aim of this study is to define the histopathological features predictive of hepatocellular carcinoma (HCC) recurrence in patients treated with orthotopic liver transplantation (OLT) after tumoral transarterial chemoembolization (TACE), in order to establish a predictive "score" applicable by pathologists for recipient risk stratification. Method: We retrospectively enrolled 110 patients (276 total neoplastic or necrotic nodules) who received TACE for HCC downstaging before OLT. The following data were collected: number of neoplastic/necrotic nodules, microscopic thrombosis, the residual neoplastic tissue (RNT), and dysplastic nodules. Sizes, percentage of necrosis, Edmondson's grade, clear cell features were also collected for each nodule. Results: Median follow-up was 1230 days: 14 (13 %) HCC recurrence cases were recorded. Statistically RNT (best cutoff 3 cm3, P=0.032), the total nodule number (best cut-off ≥ 3, P=0.001), and the neoplastic thrombosis (P=0.011) were the only variables predictive of HCC recurrence. Scoring 1+ each parameter, recipients with 0 (n=43) had 0 % recurrence rate; recipients with 1+/2+ (n=49) had 12 %; recipients with 3+ (n=18) had 44 % recurrence rate (P<0.001).