What is the role of transplantation in the management of alcoholic liver disease?

Alcoholic liver disease is a major cause of morbidity and mortality with effective pharmacotherapy being limited at present. As such, abstinence remains the cornerstone of therapy, and requires a multidisciplinary approach to address the medical and psychosocial determinants of addiction to effectively prevent relapse. Liver transplantation has a well-established role in the treatment of chronic alcoholic cirrhosis, with outcomes comparable to other aetiologies of chronic liver disease. Transplantation has been shown to be successful in highly selected candidates with acute alcoholic hepatitis (AAH), with favorable outcomes. However, AAH has not gained universal acceptance as an indication for liver transplantation, and remains controversial at present. Designing and applying objective and reliable selection rules while ensuring fair allocation in an era of organ shortage remains a challenge.