Wasting your organ with your lifestyle and receiving a new one?

Alcoholic liver disease is the leading cause of end-stage liver disease and the second most common indication for liver transplantation (OLT) in the United States and Europe, with the number of patients receiving transplants each year representing about 5% of the estimated deaths from alcoholic cirrhosis. Long-term patient survival rates compare favorable with those for other chronic liver diseases. Nevertheless, there remains a certain ambivalence about the role of OLT in patients suffering from alcoholic cirrhosis, based partly on concerns regarding alcohol relapse and functional outcome post-transplant in an era of donor organ shortage and priority setting. This review article focuses especially on compliance and social rehabilitation of patients who have undergone OLT for alcoholic cirrhosis. Furthermore, pre-transplant evaluation and selection of potential candidates are discussed and guidelines are given to clarify the role of OLT in the management of patients suffering from alcoholic cirrhosis. It appears very important to mention that alcoholism is not a fault but represents a disease, and provided that the underlying disease can be treated, consequent disease (end-stage liver disease) should be treated, too.