The main concern of this chapter is to present liver transplantation is a treatment option for both acute liver failure (ALF) and end-stage liver disease (ESLD). ALF is by far more morbid of the two states with acute and near-catastrophic multiorgan failure with the liver as the central and precipitating failed organ. Orthotopic liver transplantation has become an effective and valuable option for patients with ESLD. A functioning transplanted liver is usually associated with organ system recovery, resulting in a new life for the patient. The main focus of this chapter is on function of the liver allograft and systemic management pulmonary system, cardiovascular system, fluid and electrolytes, renal system, gastrointestinal system, central nervous system, endocrine and metabolic problems, coagulopathy and immunosuppressive therapy. Poorly functioning organ grafts including primary graft failure, small-for-size syndrome, vascular thrombosis, biliary complications and nutritional support are also discussed in this chapter.