Results of liver transplantation (LTx) have largely improved over the last few years and a one year patient survival rate of around 90% for elective transplants can now be reached. This is mostly the consequence of better patient selection and preparation, improved surgical techniques, improved intra- and postoperative care, reduced incidence of primary non function (< or =5%) and hepatic artery thrombosis (< or =5%), the understanding that the liver induces a tolerogenic response and the development of more judicious immunosuppressive protocols. Because patient and graft survival have dramatically improved, other problems become more overt and need to be addressed: side effects of long-term exposure to immunosuppression, recurrent disease, development of biliary strictures. LTx for acute liver failure continues to bring special difficulties. Strategies need to be urgently developed to augment the number of donor grafts and to combat the profound organ shortage - currently the only limiting factor to wider application of LTx.