Although steroids are commonly used in the immunosuppressive therapy after liver transplantation (LT), their role is currently under debate since their use is associated with serious short- and long- term side effects. We report about the 5-year follow-up of a prospective double-blind randomized study, whose preliminary 1-year results have already been published. Twenty-three patients received the classic triple immunosuppressive regimen (cyclosporine A (CyA), azathioprine (Aza) and prednisone (P)) in conventional doses (group A), and were compared with 21 patients given with CyA and Aza (group B). In group A, P was withdrawn within 3 months after transplant according with the Birmingham protocol. Endpoints of the study were patient and graft survival, graft function, incidence of rejection, infectious episodes and metabolic or biochemical abnormalities. Statistical analysis was carried out using the Student’s t-test and Fisher exact test. Three patients in group A died and 1 in group B. Average follow-up was 72.3 months (range: 15-89 months). Five-year survival was 83% in group A and 90% in group B respectively (p=ns). The two groups were also comparable when the other endpoints were considered. All HCV+ patients before transplant experienced hepatitis C recurrence, independently from the immunosuppressive regimen. We conclude that steroid-free immunosuppression does not affect long term (5 year) patient and graft survival, while avoids the administration of potentially toxic drugs.