A ttention to the heart before, during, and after liver transplantation can pay off in terms of better outcomes. This, even though today's liver transplant patients are older than those in the past and more likely to have fatty liver disease as the cause of their liver failure, and even though liver failure, the transplant procedure, and the posttransplant regimen can all predispose to heart disease.The changing demographics of patients receiving liver transplants and the unique cardiac pathophysiology of patients with advanced liver disease pose signifi cant challenges in managing these patients perioperatively, as we will discuss in the following sections.