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Conditions discussed in the article include Alagille syndrome, hypertrophic cardiomyopathy, Gilbert\u2019s syndrome, porphyria, Wilson\u2019s disease, and Budd-Chiari syndrome. In comparison to other indications, LT in these settings is infrequent because of the low incidence of these pathologies. Most of these conditions (with the exception of Gilbert syndrome) are associated with a high probability of significant perioperative complications and increased mortality and morbidity. Experience in management of these unusual conditions is only gained over time. 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