Max Friedländer describes the altarpiece as "a central panel showing the Last Supper ... and four other pictures, which make up the insides of the shutters, in tiers of two.

"[1] The New Testament scene of the Last Supper is the theme of the central panel of the altarpiece, commissioned from Bouts by the Leuven Confraternity of the Holy Sacrament in 1464[2] and constitutes what Maruits Smeyers names the artist's "magnum opus.

The four surrounding panels interpret Old Testament scenes with elements of food that each anticipate the Gospels' Last Supper: Feast of Passover, Elijah in the Desert, Abraham Welcoming Melchizedek, and the Gathering of Manna.

In this central panel, Bouts introduced the idea of a group portrait around a table, a theme known to council members in Haarlem.

Christ is depicted larger than life in the role of a priest performing the consecration of the Eucharistic host from the Catholic Mass.

While Bouts was working on this triptych, the church was still under construction under the supervision of members of the Keldermans family of architects, sculptors and masons.

This painting was copied by the artist's son, Aelbrecht Bouts, who disregarded the architectural elements through the windows, because by that time the church and the town square had changed.

Leuven had built a new town hall, for which Dieric also began work on four large panel paintings as an allegory of Justice.

[8] The work was documented by Leuven archivist Edward van Even in 1870,[9] who lent it to his friend James Weale for the 1902 Exhibition of Flemish Primitives in Bruges.

Germany was forced to return all the panels as part of the required reparations of the Versailles Treaty after World War I[15][7] along with the Ghent Altarpiece.

[16] The Nazis seized the wings in 1942,[15] which were then found by American forces in the complex of salt mines northwest of Altausee Austria in 1945—to be reconstituted and returned to the church in Leuven.

The paintings there are overseen and protected by the staff of the M Museum Leuven, but the outer panels of the Altarpiece of the Holy Sacrament are technically owned by the Belgian state.