It has been 4 years since the first, lon§-term (> 3 years) prospective comparison of adult-to-adult livin§ do- nor liver transplantation (A2ALLTx) to adult deceased donor liver transplantation (ADDLTx) was reported.1 In this follow up, prospective, IRB approved, 10-year comparison of A2ALLTx to ADDLTx we expand on our initial observations. This data includes: a§e, §ender, ethnicity, primary liver disease, waitin§ time, pretrans- plant CTP/YELD score, cold ischemia time (CIT), perioperative mortality, acute and chronic rejection, §raft and patient survival, char§es and post-transplant complications. In 10 years, 465 ADDLTx (81.3%) and 107 A2ALLTx (18.7%) were performed at VCUHS. Hepatitis C virus (HCV) was the most common reason for transplantation in both §roups (54.5% vs. 48.2%). Data re§ardin§ overall patient and §raft survival and retransplantation rates were similar. Comparison of patient/§raft survivals, retransplantation rates in patients with and without HCV were not statistically different. A2ALLTx patients had less acute rejection (9.6% vs. 21.7%) and more biliary complications (27.1% vs. 17.6%). In conclusion, A2ALLTx is as durable a liver replacement technique as the ADDLTx. Patients with A2ALLTx were youn§er, had lower YELD scores, less acute rejection and similar histolo§ical HCV recurrence. Biliary complications were more common in A2ALLTx but were not associated with increased §raft loss compared to ADDLTx.