Sclerotherapy and protosystemic shunt surgery are established procedures for treating bleeding esophageal varices. Liver transplantation (OLT) has not yet been established as primary therapy of portal hypertension. In a series of 43 patients with uncontrollable bleeding, shunt surgery was employed in 26 patients with contra-indications to OLT and in 2 whose liver disease had not progressed. In the remaining 15 patients, OLT was performed in urgent (n = 8) and emergency settings (n = 7). The results obtained indicate that immediate shunting in nontransplant candidates results in one-year survival for 67-83% of Child's class A or B Patients and only 42% Child's C category regardless of the type of shunt procedure performed. In transplant candidates with a similar risk status (Child's B and C) 5 of 8 patients receiving an urgent transplant and 4 of 7 patients receiving emergency OLT during active bleeding survived for one year or more. These results indicate that bleeding varices can be treated successfully by OLT.