The first liver transplantation (LT) has been performed by T.E. STARZL in March 1963. All different difficulties encountered to develop this “impossible operation” were made very clear by the fact that only 540 liver transplantations were performed worldwide during the period 1963-1983.The results of this rather small experience were finally the subject of the 1983 -NIH consensus conference (CC) on liver transplantation. This CC stated that LT could once become a valid therapeutic alternative for patients presenting with end-stage liver disease. After the introduction of the new immunosuppressive drug, Cyclosporine, in the eighties LT became more and more practiced all over the world. Most surgical groups performing this operation were trained by Professor STARZL himself first in Denver and later on in Pittsburgh. The CC identified five relative and ten absolute contraindications to LT as well as the profile of the “ideal” recipient to be ‘submitted’ to such an important surgical and medical undertaking.

This lecture will highlight all the progresses that have been made during 50 years. In fact, all relative and all, but one, absolute contraindications to LT have nowadays being eliminated. LT can be done successfully in nearly all patients presenting acute and chronic liver failure.

The very good early results obtained nowadays after LT, have shifted the attention of the transplant teams not only to the long term survival but even more to the quality of life.

Further improvement of results will most likely be linked more and more to a reduction of immunosuppressive therapies which are still the main culprits of many (lethal) cardiovascular, infectious and malignant tumor complications.

The lecture will give an overview of the huge progresses that have been made during half-century in the field of liver transplantation and hepatotology.