Quality of life is an important factor to consider when assessing the value of liver transplantation. Using a large, prospective database of liver transplantation recipients from three clinical centers in the United States, we examined the quality of life of 346 adults before and 1 year after surgery. Five quality of life domains were evaluated (measures of disease, psychological distress and well-being, personal function, social/role function, and general health perception) with standardized questionnaires completed according to established protocol. The largest numbers of patients were distressed by fatigue and muscle weakness, both before transplantation and 1 year after surgery. Compared to baseline, recipients at follow-up noted fewer disease-related symptoms (P<.001) and lower levels of distress overall (P<.001). However, levels of distress due to excess appetite (P<.001), headaches (P=.02), and poor/blurred vision (P=.05) were more likely to increase than decrease. Although 57% to 64% of the recipients were distressed by each of the psychological conditions examined at follow-up, distress was more likely to decrease than increase (P<.001), and well-being was comparable to the general population. All measures of personal functioning improved significantly (P<.05). Fifty-eight percent of the patients prevented by their disease from going to work or school before transplantation were no longer so limited at follow-up. With the exception of marriage (P=.23), all facets of social/role functioning improved more often than worsened (P<.01). Perception of health improved remarkably, with 13.4 times as many recipients reporting improved health as reporting worse health (P<.001). We conclude that liver transplantation markedly improves the quality of life of patients with end- stage liver disease.