[When to transplant a patient with alcoholic liver disease?]

When to transplant a patient with alcoholic liver disease? Alcoholic liver disease is the leading cause of cirrhosis in France, but there is only a minority of patients who have access to liver transplantation. Although still controversial, this disease is a validated indication of liver transplantation with survival similar to that of other indications. The survival benefit of transplantation is limited to patients with severe decompensation. A period of abstinence is essential before accessing to the waiting list, but the 6-month abstinence rule is not a strong criterion for predicting the recurrent alcohol consumption after transplantation. In the future, an indication of liver transplantation may be punctually made in case by-case basis in case of steroid-resistant alcoholic hepatitis. The spectrum of post-transplant relapse is a heterogeneous continuum starting with low-level point real consumption, which has little impact on patient and graft survival, up to massive consumption which substantially decreases patient long-term survival. Only a minority of patients experience massive relapse after transplantation. The prevention of relapse need an early addictive specialized management that must begin before the liver transplantation.