Liver transplantation for alcoholic liver disease

Alcoholic cirrhosis is a major public health issue in France. The prevalenc ce of alcoholic cirrhosis and the number of potential candidates for liver transplantation is unknown but certainly underestimated. Despite physicians ' ethical reserves concerning this "self-inflicted" disease and tile public 's misgivings, liver transplantation for alcoholic cirrhosis can provide su rvival rates comparable with those observed for other chronic liver disease s. in this indication, liver transplantation if often associated with a low risk of acute rejection and a high rate cancer of the upper respiratory an d digestive tracts. The risk of recurrent alcoholism after liver transplant ation is also a major problem. Its prevalence varies from 10 to 50 %, depen ding on the assessment criteria, and the rate recurrent risk for the liver graft (alcohol intake > 40 g/d) is to the order of 10 %. These figures illu strate the importance of careful management and support for these patients. At least 6 months weaning from alcohol is a commonly accepted selection cr iterion For transplantation candidates. Criteria for liver transplantation generally include patients aged under 65 years, weaned for more than 6 mont hs, with Child C cirrhosis or less, uncontrollable digestive tract hemorrha ge, spontaneous severe infection, hepatorenal syn drome, hepatopulmonary sy ndrome, or multifocal hepatocellular carcinoma if the largest nodule measur s less than 3 cm. Acute alcoholic hepatitis is a severe disease, fatal in 5 0 % of the cases, and resistant tot corticosteroid therapy. Liver transplan tation in this subpopulation of often young patient who have not achieved w eaning merits further evaluation.