Looking at preoperative kidney function in our study population we found an incidence of hepatorenal syndrome of 20% with a hazard ratio of 13, which corresponds to other studies [39] [40] [41] . Although liver transplantation can correct hepatorenal syndrome [42] , the time frame for recovery of renal function seems to be too long for RRT-free management. Often RRT is needed as a bridging therapy until the kidneys recover. In our study population, if duration of dialysis pretransplant was less than 30 days only 8% of patients still require hemodialysis 8 weeks after transplantation, which is somewhat in contrast to the study by Lo and colleagues, where 25% of the patients with hepatorenal syndrome require longterm RRT after transplantation [43] . Thus, hepatorenal syndrome is not always reversed, in particular when pretransplant RRT is necessary [44] and additional kidney transplantation becomes an option [40] . Hepatorenal syndrome prior to transplantation and RRT postoperatively are strong predictors for mortality in liver transplant recipients and the postoperative renal impairment leads to a prolonged ICU stay for these patients. Allogeneic FFP and RBC transfusions are associated with well-known adverse effects, reflected by increased incidence in viral and bacterial infections, activation of inflammatory and coagulation pathways, and immunologic reactions [45] [46] [47] . In patients after liver transplantation, intraoperative transfusion of packed RBCs are associated with more complications [48, 49] and infections [50] . Our multivariate analysis revealed transfusion of more than 7 units of RBCs and transfusion of more than 10 units of FFP as independent risk factors for mortality and prolonged ICU stay. Other reports identified intraoperative transfusion as a risk factor for morbidity and mortality in liver transplant recipients [39, 50, 51] and Massicotte and colleagues could demonstrate that a restrictive transfusion regime was associated with better outcome in liver transplantation recipients with an average MELD of 18 [49] . Thus, avoiding transfusion of RBC seems to be crucial to reduce postoperative morbidity and mortality.