Is bleeding from cirrhotic esophagogastric fundal varices end-stage liver disease? Our determination of end-stage liver disease is based primarily on the assessment of liver function. Bleeding from the esophagogastric varices is a complication of cirrhosis, not a diagnosis of end-stage liver disease. On the contrary, some patients with end-stage cirrhosis may have esophagogastric varices, but may remain free of bleeding for the rest of their lives. The use of scores to estimate liver function (5-6 for Child A, 7-9 for Child B, and 10-15 for Child C) allows for independent indicators to be considered in their entirety so that one indicator is not overly influential. Currently, we generally use the Child-Pugh scoring system, and end-stage liver disease should be defined as Child C patients. Do all cirrhotic patients need liver transplantation? Not all patients with cirrhosis require liver transplantation. The indications for liver transplantation clearly state that “any disease limited to end-stage liver disease is an indication for liver transplantation”. From this point of view, Child A and B patients do not need to rush to transplantation to a certain extent, but should focus on the management of complications and the improvement of systemic conditions. Child C patients are the absolute indication for liver transplantation. However, from the point of view of examining the severity of cirrhotic patients and from the point of view of determining the priority of donor liver allocation, it is obvious that it is not reasonable to classify the severity of liver disease into only 3 grades. The MELD score is a scoring system composed of creatinine, total bilirubin and the international ratio of prothrombin time (IRPT), in which total bilirubin has the least weight, IRPT has the most weight, and creatinine has been introduced to evaluate the severity of liver disease more comprehensively and effectively. Not only that, the MELD score also predicts mortality in patients not treated with liver transplantation. We suggest that liver transplantation should be considered when the MELD score is greater than 20, because the 90-day mortality rate of these patients is expected to reach 25%, and the Child-Pugh scoring system provides a simple way to evaluate liver function, which is commonly used in China. However, in order to more accurately assess liver function and determine the timing of liver transplantation, we strongly urge that the MELD score be introduced into the evaluation of liver transplantation patients at this stage in China, so as to make the work of liver transplantation more orderly, rational and standardized, and to promote the improvement of the treatment of portal hypertension in China. Has liver transplantation replaced traditional surgery? In the era of liver transplantation, for the treatment of patients with cirrhosis and portal hypertension, the traditional surgery to cut off the flow and shunt is still of considerable importance. According to the statistics of the National Portal Hypertension Group, the number of traditional surgeries for portal hypertension has shown a significant increase in recent years, and the statistics of 8 comprehensive tertiary hospitals in Beijing, Shanghai, Wuhan, Changchun and Nanjing found that the number of surgeries performed in the period of 2001-2006 alone has greatly exceeded the number of surgeries performed during the period of 1991-2000.Patients with cirrhosis of the liver of Child A class often do not have indications for liver transplantation, and the interruption and shunt surgery can make the liver transplantation possible. It has become the consensus of most surgeons that the interrupted flow and shunt surgery can provide patients with more satisfactory survival and quality of life, and the cost of treatment is relatively low. The choice of conventional surgery or liver transplantation should be based on the patient’s liver function status. And it should be emphasized and debated that conventional weaning and shunting procedures should be performed with an eye to the patient’s potential future liver transplantation, minimizing dissection of the first hepatic hilar and reducing adhesion of periportal tissues due to surgical manipulation. Various shunt surgeries may cause extensive visceral adhesions and thrombosis of the splenic and portal veins, while portal shunt surgery and intestinal shunt surgery can disrupt the integrity of the portal system and are therefore not recommended. We recommend splenorenal shunt surgery as the ideal procedure.