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Background and Aims: This study serves to revisit the ef-fects of liver transplantation (LT) on employment in an era of improving survival outcomes post-transplant, and to identify areas of improvement in the transplant process to better op-timize post-LT employment and patient satisfaction. Methods: Prospectively, patients who had undergone LT at a single tertiary LT center were surveyed in person and by e-mail. Primary outcomes included employment rate pre-and post-LT, annual salary, weekly hours worked, barriers to re-employment, and patient satisfaction. Results: Re-sponses were collected and analyzed from 121 patients who underwent LT. Pre-LT, 68 (56.1％) reported full-time employ-ment, 13 (10.7％) part-time employment, and 40 (33.1％) unemployment. Post-LT, 26 (21.4％) reported continued full-time employment, 18 (14.9％) part-time employment, and 77 (63.6％) unemployment. Average weekly work hours decreased post-LT (16.1 h/week vs. 39.9 h/week). Mean an-nual salaries decreased post-LT (17 eing salary$$40,000 vs. 56 eing salary $$40,000). These outcomes differed from patient pre-LT expectations, with 81.0％ of previously employed patients believing they would ret to employ-ment, resulting in decreased patient satisfaction. Patients working physically demanding jobs pre-LT were less likely to ret to work. Reasons cited for lack of ret to full employ-ment included early fatigue and difficulty regaining physical strength. Conclusions: Re-employment rates remain low post-LT, which is particularly true for patients working physi-cally active jobs. Fatigue is a significant barrier to re-employ-ment and increased physical rehabilitation post-LT may prove to be beneficial. Patients should be given realistic expecta-tions about ret to employment prior to their LT.