In Fontan-associated liver disease (FALD), what clinical scenario would lead you to pursue an evaluation for simultaneous liver-heart transplant as opposed to heart alone if there is evidence of fibrosis on a liver biopsy?

Certainly, the stage of fibrosis (F3-F4) in a good quality biopsy indicates to pursue further evaluation. The presence of varices in the esophagus (distal), thrombocytopenia, and other signs of portal hypertension on cross imaging (abdominal collaterals, splenomegaly, low protein ascites) are import...