Orthotopic Liver Transplantation in Alcoholic Liver Disease Patients

Alcoholic Liver Disease (ALD) represents the second most common indication for Liver Transplantation (LT) worldwide. Outcomes of LT for ALD are comparable with those of liver transplantation for other aetiologies of liver disease; however, it's still considered a controversial indication to LT, mainly because ALD is considered a self inflicted disease, and for the risk of relapse after LT. Most transplant programs require 6 months of abstinence in order to consider a patient suitable for LT, however the role of the length of pre transplant abstinence as predictor of alcohol relapse after LT is still controversial. A psycho-social assessment to establish the likelihood of long-term abstinence after LT should be performed in patients with ALD potential candidates for LT. Acute alcoholic hepatitis is considered a contraindication to transplantation in most transplant centers. However, early LT, in selected patients, with a first episode of severe alcoholic hepatitis not responding to medical therapy, has been shown to improve survival. Further studies are needed to better assess the risk of alcohol relapse after LT in patients with acute alcoholic hepatitis.