This patients not only has decompensated cirrhosis but a clinical syndrome called as Acute on Chronic Liver Failure which has hepatic and extra- hepatic (like kidney in this case) organ failures. These patients need early Liver Transplantation without which the survival (in weeks) is very poor. Liver transplantation can only be considered as long as kidneys have mild dysfunction. In cases with advanced kidney failure requiring Hemodialysis, outcomes of liver transplantation alone are dismal.