Candidates for hepatic transplant require a careful identification of risk factors present in the preoperative period. Child C patients have a higher incidence of renal function derangement, septic complications and mortality than Child A or B patients. Alterations in cardiovascular, renal, respiratory and neurologic systems, that sometimes constitute clearly defined syndromes, have important prognostic implications. These alterations shed doubts on the moment and indications for transplantation and on the correct preoperative management of these patients.