OBJECTIVE This study was aimed at determining if the frequency and pattern of acute liver failure (ALF) following halothane anaesthesia had decreased during the last 11 years in comparison with a previous series of 48 patients referred between 1965 and 1984 and whether clinical outcome had been altered by the introduction of liver transplantation. METHODS Between January 1985 and December 1995, all patients with halothane-induced ALF admitted to the Liver Failure Unit at King's College Hospital were identified. Four other European liver transplant centres with a known interest in acute liver failure also provided data. RESULTS Of the 18 patients admitted, the clinical data were complete in 15. Ten of these patients had at least one previous halothane anaesthesia with documented clinical complications following the earlier exposure in six. Four patients had been re-exposed to halothane within 1 month of the penultimate halothane anaesthesia. Of the 15 patients four survived with medical management alone and 11 patients fulfilled transplant criteria. Four of the latter group were not listed because of rapidly deteriorating medical state and died, and of the seven patients who were listed, three died without a liver becoming available and four were transplanted, one of whom survived. No patient who had grade 4 encephalopathy and a prothrombin time > 50 s survived without a transplant. The survey of the other European liver centres recorded a total of 19 patients with halothane-induced ALF including three cases reported in the literature. Of those, 13 patients had been transplanted with nine survivors. CONCLUSIONS Cases of halothane-induced acute liver failure still occur, albeit at a lower frequency than previously, and the Committee on Safety of Medicines guidelines are not being followed. The results of transplantation in these patients are encouraging.