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In the last 50 years of liver transplantation there has been significant improvement in all aspects of the operation, and it has become the standard of care in the treatment of end stage liver disease. Perioperative hemodynamic monitoring during the transplant operation is critical and currently the pulmonary artery catheter (PAC) remains the gold standard for cardiovascular monitoring. Transesophageal echocardiography (TEE), with the ability to visualize cardiac function and provide real-time feedback on the adequacy of intervention has had an increasing use in liver transplantation. The primary advantage of TEE is the ability to visualize cardiac function. Disadvantages of TEE include instrumentation cost, operator use, and familiarity with the information provided by the TEE. TEE provides a useful adjunct to PAC in intraoperative hemodynamic monitoring during liver transplantation, especially in those patients at risk for cardiac complications due to pre-existing cardiovascular disease.