Medical selection criteria should be the same for all patients with end-stage liver disease and should aim for an acceptable outcome of the liver transplant procedure in matter of survival and quality of life, taking the scarce resources into account. The psychiatric selection criteria should aim at avoidance of recidivism of alcohol use in alcoholic patients. At least 6 mo of sobriety should be required. The patient must have a stable and supportive environment and should participate in an alcohol counseling program. A multicentered trial using uniform scoring criteria such as the Alcohol Prognosis Scale is needed to better define the selection of patients with alcoholic liver disease and long-term outcome of alcoholism after transplantation. (HEPATOLOGY 1994;20:28S-328.)
Liver transplantation was recognized as a modality of treatment for end-stage liver disease during the National Institutes of Health Consensus Conference in 1983, and its potential for end-stage cholestatic, parenchymal and metabolic liver disease was defined (1). In that context a short paragraph was devoted to alcoholrelated liver disease. Although it was recognized that alcohol-related liver disease is the most common form of fatal liver disease in America, the assumption was also made that only a small proportion of alcoholic patients would meet the rigorous criteria for liver transplantation. These rigorous criteria were related to the medical condition of the patient as well as to alcoholism. Specifically, the patient's abstinence from alcohol was stated as one of the criteria. Five years later, Starzl (2) published the first paper on the results of liver transplantation in alcoholic patients. He demonstrated that the survival of patients with end-stage alcoholic liver disease was equal to that of patients with end-stage liver disease from other causes. Since then the percentage of patients receiving liver transplants for end-stage alcoholic liver disease has increased to 22% of all transplants performed in 1992. In 1990 36,000 patients died from alcoholic liver disease in the United States. The 600 patients who received liver transplants in 1992 are