PPHTN is a common complication of portal hypertension in candidates for liver transplantation. The pathophysiology is unknown, and the diagnosis only can be made by pulmonary artery catheterization. Although candidates for liver transplant need to be screened for this complication, the frequency of screening that is necessary in this population is unknown. Novel medical therapies for PPHTN may be emerging, but randomized clinical trials have not focused on this severely compromised patient population. In general, OLT and TIPS should not be performed in patients who have significant PPHTN. Strategies to risk-stratify the patients who may tolerate one or both procedures safely should be investigated.