Orthotopic liver transplantation (OLT) has been accepted as the standard treatment for end stage liver disease since 1983. Establishment of a new program has specific problems and lessons. From January 2002 to July 2007, 27 OLT were done in Imam Khomeini Hospital Complex, Tehran, Iran. In the first series of 9 cases which was performed within 4 years, the standard technique was done in all except one patient. We changed the procedure to piggy back hepatectomy and cavocavoplasty in the second series of 18 patients except for 1 case. This group was operated on in a 20 months period. There were 5 female patients in the group one and 7 in the latter. Mean age of the patients in the two groups were 28 and 43.3 years respectively. Mean Child-Pugh score was 10.1 in group one and 9.68 in group two. The most common indication for transplantation was hepatitis B followed by cryptogenic cirrhosis. We had 5 (55%) early postoperative mortalities in the first group and 4 (22%) in the second. Causes of death in the first group were intra-operative bleeding, primary non function, postoperative hemorrhage due to DIC (two patients) and Klebsiella sepsis. Four mortalities in the second group were due to primary non function, pulmonary sepsis and heart problems (MI and congestive heart failure). We had no early biliary complication. The mean operative time for the second group was 7:51 with cold ischemia time of 7:16. Outcome of OLT could be rapidly progressed with judicious refinement of technique and increasing number of transplants. 78% one month survival may be an indicator of passing learning curve.