Liver transplantation for alcoholic liver disease (ALD) is controversially discussed. Although overall survival after liver transplantation is similar to other indications, long-term survival is significantly reduced in patients with recurrence of excessive alcohol consumption. Criteria of transplant eligibility and prediction of risk of alcohol relapse after transplantation are the core concerns in this setting. Most transplant centres therefore require an abstention period of 6 months prior to listing. However, data on the ‘6-month rule’ as a surrogate parameter for prediction of relapse are conflicting, and first reports on liver transplantation in highly selected patients with acute alcoholic hepatitis without response to medical treatment are promising. Therefore, a thorough pre-transplant evaluation by an experienced addiction specialist in addition to regular counselling and a highly supportive social surrounding after transplantation seem to be the key factors for long-term survival in ALD patients.
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