Clinical trials of neural grafting for Parkinson's disease (PD) have produced variable, but overall, disappointing results. One particular disappointment has been the development of aberrant motor complications following dopamine (DA) neuron grafting. Despite a lack of consistent benefit, the utility of dopamine neuron replacement remains supported by clinical and basic data. In a continued effort to elucidate factors that might improve this therapy, we used a parkinsonian rat model to examine whether pre-graft chronic levodopa impacted graft efficacy and/or graft-induced dyskinesia (GID) induction. Indeed, all grafted PD patients to date have had a pre-graft history of long-term levodopa. It is well established that long-term levodopa results in a plethora of longlasting neurochemical alterations, and genomic changes indicative of altered structural and synaptic plasticity. Thus, therapeutic dopamine terminal replacement in a striatal environment complicated by such changes could be expected to lead to abnormal or inappropriate connections between graft and host brain, and contribute to suboptimal efficacy and/or post-graft GID behaviors. To investigate the impact of pre-graft levodopa, one group of parkinsonian rats received levodopa for 4 weeks prior to grafting. A second levodopa naïve group was grafted and grafts allowed to mature for nine weeks prior to introducing chronic levodopa. We report here that in parkinsonian rats, pre-exposure to chronic levodopa significantly reduces behavioral and neurochemical efficacy of embryonic dopamine grafts. Further, dopamine terminal replacement prior to introduction of chronic levodopa is highly effective at preventing development of levodopa-induced dyskinesias, and GID-like behaviors occur regardless of pre-graft levodopa status.