As with other programs across the country, at the University of Pittsburgh liver transplantation continues to evolve after three decades. The shortage of organs represents the biggest problem in the field, and in response there has been an increase in the number of expanded-criteria-donor transplants and other methods to expand the donor pool such as live-donor, domino, and split-liver transplants. As the program has matured, we have seen an increasing number of recipients needing re-transplantation because--unlike with kidney transplants--recurrence of disease represents a significantly greater problem than immunologic graft failure. Modern immunosuppression, especially with agents such as tacrolimus, have significantly reduced the immunologic problems associated with liver transplantation. But as survival rates have improved and patients are living longer after transplant, the problems associated with long-term immunosuppression have become increasingly important. Our program, along with others, continues to look at methods to minimize the overall amount of long-term immunosuppression to which patients are exposed.