We read the recent report regarding the role of echocardiography in the preoperative evaluation for liver transplantation (LT). We would like to share some thoughts and concerns regarding the importance of the development of lung vascular disorders in the setting of liver disease or portal hypertension, in particular, the development of portopulmonary hypertension. Right heart catheterization (RHC) represents the reference standard for the diagnosis of portopulmonary hypertension. Despite the poor agreement between echocardiographic and RHC parameters, LT programs have successfully used the right ventricular systolic pressure (RVSP) to identify patients needing RHC; however, the cutoff values of RVSP vary depending on in which center the patient is being evaluated for LT (e.g., Mayo Clinic, University of California, San Francisco, Medical Center). Because of these factors, we would like to raise the following questions: (1) what was your RVSP cutoff value to strongly consider RHC?; (2) what was the percentage of patients who underwent diagnostic RHC?; and, finally, (3) what proportion of patients during RHC experienced an increased pulmonary blood flow phenomenon (e.g., hyperdynamic state due to fluid overload with normal or low pulmonary vascular resistance) versus true vaso-occlusive arteriopathy? We understand that an important limitation of your study was the lack on RHC. We believe that future portopulmonary hypertension guidelines should focus on defining the RVSP cutoff values and other key echocardiographic aspects to delineate which pre-LT patients need RHC.