Alcoholic liver diesease (ALD) is still the most frequent and lethal complication in chronic alcoholism. Primary treatment modalities are abstinence, agents that suppress inflammation, anticytokine therapy and nutritional support, among others. For alcoholic liver cirrhosis, transplantation is an accepted option but requires careful consideration of alcohol history and future prognosis resp treatment options. Although there is a relationship between the lemgth of sobriety and future abstience, the present methods to predict future drinking are inexact. Approximately 20% of patients return to harmful drinking after transplantation (Lucey, 2011). Compared with other patient groups, relapse rates in patients with ALD are low. A number of other clinical variables apart from length of abstinence (Tandon et al. , 2008) may predict outcome as alcohol research shows. This may include alcohol-associated symptoms, previous treatments and psychopathological symptoms including cogntion and history of suicide attempts. In general, DSM-IV-Tr alcoholism criteria appear to have greater utility for predicting survival differences beyond pathophysiologically defined alcoholic liver failure (Rowley et al. , 2010). Implications for diagnosis and treatment are discussed. REFERENCES Lucey M (2011) Liver transplantaion in patients with alcoholic liver disease. Liver Transpl , doi. 10.1002/lt.22330. Rowley AA, Hong BA, Chapmna W et al. (2010) The psychiatric disgnosis of alcohol abuse and the medical diagnosis of alcoholic related liver disease: effect on liver transplant survival. J Clin Psychol Med Settings 17 :195–202. Tandon P, Goodman KJ, Ka MM et al. (2009) A shorter duration of pre-transplant abstinence predicts problem drinking after liver transplantation. Am J Gastroenterol 104 :1700–1706. # S16.4 EARLY LIVER TRANSPLANTATION AS A RESCUE OPTION FOR PATIENTS WITH SEVERE ALCOHOLIC HEPATITIS NON-RESPONSIVE TO THERAPY: A CHANGE OF PARADIGMS? {#article-title-2} Although liver transplantation (LT) for alcoholic liver disease has a favorable outcome, it remains controversial in the eyes of the public. To ration organs, most programs require a 6-month period of abstinence prior to evaluation of alcoholic patients, which is presumed to: (a) permit patients to recover from liver failure; (b) identify subsets of patients likely to maintain abstinence after LT. Acute alcoholic hepatitis (AAH) is the most severe form of alcoholic liver disease. In its severe form (defined by a discriminant function ≥32), the risk of dying within 2 months is 40–50%. A recent analysis of individual data from five randomized controlled studies evaluating corticosteroids in severe AAH patients demonstrated a better short-term survival in the group of patients treated by steroids. The so-called Lille model enables clinicians to identify early on those patients unlikely to respond to medical management. Using this approach, strict application of the 6-month rule may be unfair to such patients, since 70–80% of them die prior to the end of the sobriety period. Alternative therapies, such as pentoxifylline or MARS therapy, have been demonstrated to be inefficient in patients non-responsive to corticosteroids. The recent French and Belgian pilot experience in highly selected patients showed that early LT clearly improves 6-month survival of patients with severe AAH refractory to medical management. In this preliminary experience, the relapse rate was limited and occurred late after LT. This approach opens new perspectives for such patients, but will need a drastic selection of candidate patients by expert centers. These encouraging results must be confirmed by other groups. REFERENCES Lucey M, Mathurin P, Morgan TR (2009) Alcoholic hepatitis. N Engl J Med 360 :2758–2769. Mathurin P, O'Grady J, Carithers RL et al. (2011) Corticosteroids improve short-term survival in patients with severe alcoholic hepatitis: meta-analysis of individual patient data. Gut 60 :255–260. Louvet A, Naveau S, Abdelnour M et al. (2007) The Lille model: a new tool for therapeutic strategy in patients with severe alcoholic hepatitis treated with steroids. Hepatology 45 :1348–1354. Louvet A, Diaz E, Dharancy S et al. (2008) Early switch to pentoxifylline in patients with severe alcoholic hepatitis is inefficient in non-responders to corticosteroids. J Hepatol 48 :465–470. Moreno C, Duclos-Vallee JC, Castel H et al. (2010) Early transplantation improves survival of non-responders to corticosteroids in severe alcoholic hepatitis: a challenge to the 6 month rule of abstinence. Am J Transplant A398.