Hepatitis C (HCV) is one of the commonest causes of liver cirrhosis in Saudi Arabia. Recurrence of hepatitis C after liver transplantation (LT) is universal and is associated with significant morbidity and the possible need for re-transplantation. There is no clear consensus on the best approach to recurrent hepatitis C post transplantation but most centers take a selective approach versus preemptive treatment. The aim of this study is to document our experience with a selective approach to these patients and deciding on therapy based on the patient’s clinical condition and liver biopsy results. We reviewed the charts for 24 patients who have undergone LT between 1998 and August 2004. Various demographic, clinical, and biochemical parameters were collected. The type of transplantation and the immunosuppression used was also recorded. The total number of patients was 24. The average age was 53. Eight patients were females and 16 were males. 15 patients had cadaveric transplant, eight had living related liver transplant (LDLT), and one patient had cadaveric transplant after LDLT. The mean follow-up period was 19.4 months (1 to 60 months). 13 patients were infected with genotype 4 and 2 with genotype 1. One patient had a mixed infection with genotype 4 and 6. Four patients were un-typable in our laboratory and in 4 patients the genotype was unknown. One living-related transplant recipient had aggressive recurrence that required re-transplantation with cadaver transplant. Four patients had recurrent hepatitis C requiring treatment. These patients had different stages of fibrosis and grades of inflammation. Two patients with lobular hepatitis but no fibrosis, one patient with grade 1 inflammation and stage 1 fibrosis, and one patient with grade 2 inflammation and stage 2 fibrosis. Three patients responded to therapy very well biochemically and viral load respond nicely. The viral load was variable between 300,000 up to 40, 000. The commonest immunosuppression used in these patients was Tacrolimus and Steroids (used in 9 patients). Tacrolimus and MMF was used in four patients, Cyclosporin and steroids in three patients, and Tacrolimus alone in two patients. Other immunosuppression regimes were used in the other five patients. A selective approach to post transplant patients with hepatitis C is safe and effective. Patients should be evaluated individually and if found appropriate treatment with pegylated interferon and ribavirin should be started.