Acute kidney injury (AKI) is a common complication of orthotopic liver transplantation (OLT) occurring both in the pre- and postoperative period. It significantly worsens prognosis. Performing renal replacement therapy (RRT) is difficult in these patients and may cause numerous problems. The patients usually remain in serious condition, are hemodynamically unstable, at risk of brain edema, and suffer from acidosis and electrolyte imbalance. They require multi-drug treatment, parenteral nutrition, and use of life support devices. Here, we present the advantages and disadvantages of selected RRT methods, as well as problems associated with anticoagulation. We also discuss the possible extrarenal indications for RRT in liver transplant patients and the preliminary data on intraoperative RRT.