In contemporary LT evaluation, when do you move away from functional stress testing as the default CAD screen in cirrhosis and instead choose coronary CT angiography or upfront invasive angiography, and which clinical features most reliably drive that choice (limited exercise capacity, chronotropic incompetence, CKD, severe vasodilatory physiology)?

There is no universal answer to this question. While guidelines offer framework definitions, every transplant center faces a unique set of challenges. A center's protocol is ultimately dictated by its specific patient population's risk profile, local waitlist times/transplant availability (high vs. low MELD regions), institutional access to advanced imaging, and a continuous effort to mitigate cardiovascular death (CVD), which remains a leading cause of early post-transplant mortality nationwide...