**5.3 Alcoholic Liver Disease (ALD)**

Patient selection for liver transplantation has always been a demanding responsibility for transplantation teams and professionals. In alcoholic liver disease patients, issues related to liver transplantation have remained unresolved despite the convincing reports of similar survival post transplant in selected ALD patients, compared to those who received transplant for other indications (Roberts, 2004).

A period of abstinence is recommended for alcoholics before being considered possible candidates for transplant and before being accepted to undergo the procedure (Kotlyaar, 2008). Also a reasonable familiar and social support is required. DiMartini et al. have proposed a selection method to identify alcoholic patients suitable for transplantation. Lucey et al have reported on a multidisciplinary collaboration of transplant hepatologists, surgeons and psychiatrists that identifies psychosocial predictors of long term sobriety and compliance after liver transplant in alcoholics (Weinrieb and Lucey, 2007; Dew, 2008). Pretransplant abstinence has two purposes; it allows a window of opportunity for the liver to stabilize (it is not exceptional that some cases have been withdrawn from the waiting list due to improvement), and it allows the opportunity to examine the patient's commitment.

#### **5.3.1 Alcoholic Acute Hepatitis**

No systematic evaluation has been performed on patients transplanted for alcoholic liver disease (ALD). Data are limited on the impact of structured management of the alcohol problem on the risk of recidivism following transplantation in ALD. The question of a possible transplant during the acute episode remains unanswered. In these patients short term survival is good after transplant. However, due to the relative scarcity of donors, the majority of transplant teams do not accept to list patients who are actively consuming alcohol. (Cowling, 2004), but it is controversial (Mathurin, 2011).
