The benefit of antiviral treatment in recurrent hepatitis C after liver transplantation remains unclear. The aim of this study was to determine whether antiviral treatment improved histologic outcome in recurrent hepatitis C. All patients who were transplanted for hepatitis C from January, 1998 to December, 2000 were offered treatment with interferon alpha 2b (3 million units three times per week) and ribavirin (800 mg/d) for 1 year. All patients underwent liver biopsy before and after treatment. Virologic assay was performed at 3 months and at 1 year. Among the 33 patients, 13 managed 80% of total doses of both interferon and ribavirin. Dose reduction or discontinuation was necessary in others. In an intention to treat analysis, the overall virologic response at 3 months and 1 year was 27% and 12%, respectively. On an intention to treat basis, the overall histologic response showed little benefit. In the subgroup of patients who received full treatment, there was a trend towards benefit in regard to inflammation (per histologic activity index [HAI] score). However, the fibrosis score was comparable in both groups, and complete antiviral treatment did not improve the fibrosis score or prevent progression of fibrosis. In the posttransplant setting, it is often extremely difficult to give a full course of treatment with existing antiviral regimes. In an intention to treat analysis, the overall benefit of antiviral treatment in recurrent hepatitis C is disappointing, with little impact on the progression of fibrosis.