Re-transplantation (Re-TX) is the only lifesaving and therapeutic option for irreversible liver graft failure and constitutes 8% to 17% of procedures in several studies. Earlier reports suggest that the survival after liver re-transplantation (Re-TX) is inferior to that for primary liver transplantation. The reported 1-year patient or graft survival rates after Re-TX ranges from 50 to 60%. Careful analysis of the potential benefits is essential to justify its role in an era of organ shortage and rising costs. However, medical, ethical, and financial aspects concerning this procedure are complex and somewhat controversial. Patients undergoing early Re-TX for acute HAT thrombosis or PNF fare better than late re-transplantation. The need for emergent early Re-TX is progressively declining due to improvements in immunosuppressive therapy, surgical technique, organ preservation, and a better understanding of primary non-function. An expected 1-year survival rate of less than 40% is considered a contraindication for Re-TX and urgent Re-TX should be considered with caution and on a case-by-case basis. Living-related TX may be an option. In the future, the need for late liver re-OLT may represent a growing problem. Recurrence of viral disease (HCV) and chronic biliary graft failure may increase further. Re-TX for HCV recurrence carries worse prognosis.