Liver insufficiency and portal hypertension are the two drivers of hepatic and extrahepatic manifestations during cirrhosis, whatever the cause of the disease. The main mechanisms are explained by both hemodynamic disturbances and systemic inflammation. Bacterial infections are also very common and result in complex mechanisms. The onset of acute kidney injury and hepatic encephalopathy is associated with a high mortality rate. So-called cirrhotic cardiomyopathy could result in adaptive response of persistent portal hypertension and hemodynamic abnormalities, but its prognostic impact is less clear. Interestingly, all extrahepatic complications are fully reversible after liver transplantation.