Liver Transplantation for Alcoholic Liver Disease An Update Elizabeth L. Godfrey, BSBE a, *, Rise Stribling, MD b , Abbas Rana, MD b INTRODUCTION Alcoholic liver disease (ALD) is a serious contributor to the global liver disease burden, is likely on the increase, and is treatable only with liver transplantation (LT) when suf- ficiently advanced. Extensive selection criteria, including a specified period of sobri- ety, has been used in the past to attempt to ensure good outcomes; however, new Disclosure Statement: The authors have nothing to disclose. a Department of Student Affairs, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; b 6620 Main Street, Suite 1425, Houston, TX 77030, USA * Corresponding author. E-mail address: Elizabeth.Godfrey@bcm.edu KEYWORDS  Alcoholic liver disease  Liver transplantation  Alcoholism  End-stage liver disease  Alcoholic hepatitis KEY POINTS  Alcoholic liver disease (ALD) is a prominent contributor to the world liver disease burden. Current research predicts that it is fast becoming the most common cause of end-stage liver disease.  Determining eligibility for transplantation for ALD requires evaluation of a patient’s relapse risk and an effective management plan for the patient’s substance use disorders. Inte- grated alcohol abuse treatment teams should use a mixture of psychosocial and pharma- ceutical interventions.  Patients with ALD require careful management of malnutrition and other comorbidities while on the waitlist. After transplantation, monitoring for de novo malignancy and meta- bolic conditions is critical.  Many transplant programs have replaced a mandatory 6-month sobriety period with other requirements because of good outcomes in patients who are transplanted early for severe alcoholic hepatitis.  Long-term outcomes for transplantation for ALD compare favorably to other indications for liver transplantation. Alcohol relapse occurs in approximately 17% to 22% of patients but only occasionally causes further liver disease. Clin Liver Dis 23 (2019) 127–139 https://doi.org/10.1016/j.cld.2018.09.007 liver.theclinics.com 1089-3261/19/ª 2018 Elsevier Inc. All rights reserved.