Liver transplantation has become a widely accepted form of therapy for many life-threatening liver illnesses. Since the introduction of CsA in 1980, numerous centers have opened and now more than 800 liver transplants are performed in the United States per year. In most large series, a 70% 5-year survival rate is seen. However, in terms of survival, hepatic transplantation for carcinoma continues to lag behind other diseases. In the absence of an available alternative treatment for this group of patients, vigorous investigation into prevention of recurrences following OLT is needed. Despite the proliferation of liver transplant programs, optimization of postoperative care remains a major challenge for those physicians who care for these patients. Too often, the diagnosis of rejection in contrast to infection is guided by clinical suspicion rather than firm evidence. Reversal of multiorgan dysfunction is often aggravated by the very immunosuppressants which allow transplantation. Maximizing graft acceptance and organ function while minimizing infectious complications remains the ultimate goal for transplant surgeons and is the key to further success.