The 2-year probability of presenting SR was significantly higher in LDLT compared to CLT (45% vs. 22%, P ؍ .019). By univariate analysis LDLT (P ؍ .019) and an ALT higher than 80 IU/L 3 months after LT (P ؍ .022) were predictors of SR. In 93 patients from whom a liver biopsy was available 3 months after LT, a lobular necroinflammatory score >1 (P < .01), LDLT (P < .01), and biliary complications (P ؍ .046) were associated with SR. However, the only variables independently associated with SR were LDLT (odds ratio [OR], ؍ 2.8; 95% CI,1.19-6.6; P ؍ .024) and a lobular necroinflammatory score >1 (OR, 3.1; 95% CI, 1.2-8; P ؍ .013). In conclusion, HCV recurrence is more severe in LDLT compared to CLT. Although our results were based on a single-center experience, they should be considered in the decision-making process of transplant programs, since severe HCV recurrence may ultimately compromise graft and patient survival. (HEPATOLOGY 2004; 40:699 -707.)