Liver transplantation has evolved as the treatment of choice for many patients with end-stage liver disease. Currently, survival posttransplant is excellent, with 10-year survival exceeding 65%. Causes of graft failure include recurrent disease, in particular autoimmune disease, alcoholic liver disease, and NAFLD. Immune-mediated injury is also a cause for graft failure, but this cause has proved to be less common nowadays. With the actual range of potent immunosuppressive agents and a greater use of a tailored approach, rejection is seen less frequently. Rejection may take the form of T-cell-mediated rejection (TCMR), antibody-mediated rejection (AMR), and plasma cell-rich hepatitis. On the opposite end of the spectrum, operational tolerance develops in a small proportion of liver transplant recipients. Finally, as indicated earlier, some autoimmune diseases can recur in the allograft.