End stage liver disease (ESLD) is associated with cardiovascular complications that can range from hyperdynamic circulation to up–front heart failure in cirrhotic cardiomyopathy (CCM). Patients with cirrhosis can present with pulmonary involvement and the most common manifestations are porto-pulmonary hypertension (PoPH) and hepatopulmonary syndrome (HPS). Transplant eligibility and medical management are different in the presence of these entities. The prevalence of CCM is high among cirrhotic patients, but because of the absence of symptoms at rest and the preserved left ventricle systolic function, the diagnosis is frequently missed. Severity of CCM correlates with the severity of the liver disease and is associated with worse outcomes before and after transplant. Introduction of new criteria in 2019 that include new imaging techniques like global longitudinal strain and a more detailed diastolic function assessment aims to improve recognition. PoPH is a life-threatening complication despite its low prevalence. A mean pulmonary artery pressure above 45 mmHg is an absolute contraindication for liver transplant. Invasive diagnostic confirmation is mandatory and specific medical therapies can improve the hemodynamic profile, allowing listing for transplant. At the opposite end, patients with HPS and high symptom burden, with severe hypoxemia should be listed for transplant early, as no other treatment option exists.