In patients with cirrhosis and kidney dysfunction who are candidates for liver transplantation, transplant decisions are impacted by kidney function impacting MELD scores. This podcast explores ICU management of these patients, including the use of dialysis, and emphasizes the importance of considering multiple factors such as the etiology of liver disease, presence of chronic kidney disease, and individual patient characteristics. The experts highlight recent changes in transplant criteria, particularly for alcoholic hepatitis patients, and discuss the challenges of managing an increasingly diverse patient population ranging from young alcohol-related liver disease patients to older patients with metabolic-associated liver disease and multiple comorbidities.