Chronic rejection (CR) after liver transplantation is thought to be a dynamic and potentially reversible process. The Banff working group has developed recommendations for its histopathologic staging. The 1999 Banff classification of CR (i.e., bile duct dystrophy of > 50% and/or bile duct loss of > 20%) was applied to biopsies from patients retransplanted for CR (N=19), and pathologies other than CR (N=21) to evaluate its specificity and sensitivity, especially of the early stage lesions of CR. In addition, atypical forms of CR were described. Including an early stage into the definition of CR, has resulted in a much higher sensitivity for its diagnosis, as compared to the former classification (i.e., bile duct loss of > 50%) (89% vs 33%, p = 0.0001), while keeping an acceptable specificity (74% vs 100%, p = 0.03). When bile duct loss of > 20% and bile duct dystrophy of > 20% were combined, the sensitivity was higher and the specificity was lower than the Banff classification, but the difference was not statistically significant. Transient lobular hepatitis, unrelated to viral infection, and veno-occlusive disease were seen significantly more often in the CR group. We conclude that the application of 1999 Banff classification is superior to the former classification for the diagnosis of CR. However, lowering the limit of bile duct dystrophy from 50% to 20% for the diagnosis of early CR is also suggested. Transient lobular hepatitis, unrelated to viral infection and veno-occlusive disease may be unusual expressions of CR.