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After liver transplantation, there remains a need for precise markers for evaluation of grafts. We investigated whether serum cholesterol value can serve as a marker for evaluation of the transplanted liver during follow-up. The effect of liver transplantation involving living related donors was investigated in 40 recipients in terms of lipid metabolism as measured by serum cholesterol. The relationship between cholesterol value after transplantation and liver graft weight/body weight (LW/BW) was also examined. Serum cholesterol increased at 10-20 days post-transplantation in successful cases, stabilizing at a value of more than 100 mg/dl after 4 weeks post-transplantation. In unsuccessful cases, serum cholesterol showed little increase in the 3 weeks after transplantation, and thereafter continued to decline. Cholesterol levels never reached 100 mg/dl in any of the unsuccessful transplantation cases. It took 45 days on average for the serum cholesterol to reach 100 mg/dl in recipients with less than 1% LW/BW ratio graft, but only 10 days in recipients with more than 3% LW/BW ratio graft. Patients who had partial liver transplantation from living related donors showed rapid recovery of cholesterol synthesis. However, patients with liver grafts required an extensive period before normalization of cholesterol synthesis, suggesting a need for long-term follow-up of graft recipients.