Cirrhosis caused by chronic hepatitis is currently one of the leading indications for liver transplantation among adults in the United States and western Europe.' Chronic infection with hepatitis C virus (HCV) is a relatively common condition affecting approximately 1.4% of the general population in the United States (Alter M, Personal communication, April 1994). Thus the number of infected individuals is very large (approximately 3.5 million in the United States) and although only a very small percentage of them develop cirrhosis with liver failure this amounts to a significant number of patients in absolute terms. In the United States in 1993, approximately 2,600 orthotopic liver transplants were performed in adults, of which 711 (27%) were for chronic hepatitis C with cirrhosis (Detre KM, Personal communication based on United Network for Organ Sharing data, May 1995). Graft and patient survival after transplantation are generally good, at least for the first few years, and are comparable to those after transplantation for primary biliary cirrhosis, sclerosing cholangitis, and cryptogenic cirrhosis.' Nonetheless, it has become apparent that recurrent infection with the HCV is almost universal after liver transplantation, and concerns about the longterm outcome of this procedure have arisen after reports of chronic hepatitis progressing to bridging hepatic fibrosis or even cirrhosis among patients with recurrent HCV infe~tion.~ Several major transplant centers have documented their experience of liver transplantation for hepatitis C. Results from these various centers are difficult to compare because of the different ways of evaluating HCV recurrence. Some investigators have focused mainly on histological evidence of hepatitis, whereas others have emphasized the reappearance of HCV RNA in serum. Otherwise unexplained increases of serum aminotransferase levels are useful indicators of appearance of liver disease but are not particularly specific in the posttransplantation setting. Adding to these difficulties is the lack of uniformity in timing of liver biopsy specimens. At some centers, "protocol" biopsies