Purpose: This study was designed to evaluate the efficacy and safety of microwave ablation (MWA) in the treatment of intrahepatic recurrence of hepatocellular carcinoma (HCC) after liver transplantation. Materials and methods: Between October 2008 and August 2014, a total of 11 cases with 19 lesions were enrolled. All the subjects had confirmed HCC recurrence after liver transplantation by at least two types of enhanced imaging. Real-time monitoring and small ethanol doses were used as an additional technique to assist with ablation. Contrast imaging was performed to evaluate the technique efficacy. The technique efficacy rate, local tumour progression rate, 3, 6, 9, 12, 18 and 24 months survival rates, and the incidence of complications were comprehensively analysed. Results: The follow-up period ranged from 5–33 months. All tumours achieved full ablation. The first MWA technique efficacy rate was 84.2% (16/19), while the second technique efficacy rate was 100%. Local tumour progression was identified in three cases (15.8%) at 1, 3 and 7 months after MWA. The 3, 6, 9, 12, 18 and 24 months accumulative survival rates were 90.9%, 81.8%, 71.6%, 51.5%, 30.7% and 15.3%, respectively, the average survival time was 17.3 months (3.5–33 months). Mild side effects included five patients (45.4%) with fevers, three with (27.3%) nausea and vomiting, five (45.4%) with local pain, and eight (72.7%) with increased blood transaminase levels; no serious complications occurred. Conclusion: MWA treatment is a promising technique for intrahepatic recurrence after liver transplantation without serious complications or side effects.