Veldt et al evaluated patients with severe alcoholic cirrhosis for liver transplantation. A patient with alcoholic liver disease needs to be carefully selected in order to justify the procedure. The authors are from Centre Hospitalier Universitaire in Rennes, France.


Prognostic factors associated with a poor outcome for a patient with severe alcoholic cirrhosis:

(1) continuing to drink

(2) initial renal failure

(3) initial elevation of serum sodium (hypernatremia)


Indications for liver transplantation for alcoholic cirrhosis - all of the following:

(1) Child C cirrhosis

(2) severe complications (refractory ascites, chronic encephalopathy, extreme fatigue, recurrent hemorrhage)

(3) persisting liver failure after 6 months of abstinence from alcohol

(4) failure to respond to conservative management

(5) absence of contraindications


Some patients who become abstinent have sufficient improvement of liver function that a liver transplant may not be necessary.


A patient who has failed to have improvement in liver function despite 3 months of abstinence is unlikely to improve in the subsequent 3 months, so should be considered for liver transplant if the other criteria are met.


Contraindications to liver transplantation:

(1) continuing to drink

(2) hepatocellular carcinoma not suitable for liver transplantation

(3) advanced age

(4) psychosis or other severe psychiatric disorder

(5) other contraindications


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