Liver transplantation for alcoholic liver disease

Although increasing numbers of alcoholic patients are being referred to liv er transplant centres, liver transplantation for alcoholic liver disease st ill remains controversial, essentially because we are in an era of organ sh ortage. In fact, the main issue is the likelihood of relapse and its influe nce on outcome, because it is the possibility of returning to alcohol use t hat separates patients with alcoholic liver disease from those with other f orms of chronic liver disease. In all proposed clinical guidelines of indic ations for referral and assessment for liver transplantation for alcoholic liver disease, the authors emphasize the risk of alcoholism recurrence and, thus, a multidisciplinary approach is required to select patients who are likely to comply with follow-up and not return to a damaging pattern of alc ohol consumption after transplantation. It emerges from all clinical studie s that when we take into account the usual criteria of success for liver tr ansplantation, i.e. patient and graft survival, rejection rate and infectio n rate, alcoholic liver disease is a good indication for liver transplantat ion. Predictive factors for alcoholic relapse after liver transplantation h ave been assessed in numerous studies, often with contradictory results mak ing these difficult to analyse and compare. Several predictive factors for alcoholic relapse have been studied: length of abstinence before transplant ation, associated psychiatric problems, social conditions, associated drug addiction, age. Abstinence after transplantation is the goal, but the neces sary treatment for alcoholic disease can result in considerable improvement , even when complete abstinence is not achieved. Finally, the good results obtained with liver transplantation for alcoholic liver disease should help us to educate the general population about alcoholic disease.