Peer-reviewedCC BY 4.0Journal of Clinical Medicine11 Oct 2026

Liver Transplantation for Alcohol-Related Liver Disease in 2026: Phenotypes, Selection, and Post-Transplant Care

Alberto Ferrarese^1,2
Giovanni Perricone³
Laura Vivian^2,4
Alberto Zanetto^2,4
Guido Viel⁵
Patrizia Burra^2,4
Alexandre Louvet⁶
Giacomo Germani^1,2

6 affiliations

¹Multivisceral Transplant Unit, Padua University Hospital, Via Giustiniani 2, 35122 Padua, Italy
²Department of Surgery, Oncology and Gastroenterology, Padua University, 35122 Padua, Italy
³Hepatology and Gastroenterology Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
⁴Gastroenterology, Padua University Hospital, 35122 Padua, Italy
⁵Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua University, 35122 Padua, Italy
⁶CHU Lille, Lille University, 59037 Lille, France

Abstract

Liver transplantation (LT) for alcohol-related liver disease (ArLD) has evolved from a pathway centered on decompensated cirrhosis and prolonged abstinence to one that also encompasses severe alcohol-related hepatitis (sAH) and alcohol-related acute-on-chronic liver failure (ACLF). This change reflects the growing burden of ArLD and evidence that carefully selected patients with acute presentations can achieve excellent post-transplant survival. The traditional six-month abstinence rule has limited value as a stand-alone predictor of harmful post-transplant alcohol use. International guidance increasingly supports individualized multidisciplinary assessment of alcohol use disorder (AUD), psychiatric comorbidity, social vulnerability, insight, and treatment engagement, although listing requirements remain heterogeneous. Abstinence nevertheless remains a disease-modifying intervention that may promote clinical improvement, hepatic recompensation, and delisting in selected candidates. After LT, long-term care should integrate prevention and treatment of harmful alcohol use with surveillance and management of graft-related, cardiometabolic, oncologic, infectious, and other medical complications. This narrative Perspective critically appraises LT for ArLD in 2026 and proposes a phenotype-informed framework integrating medical urgency, dynamic reassessment, alcohol-use biomarkers, and longitudinal transplant–addiction care.

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Cite

BibTeX RIS

BibTeX

@article{ferrarese2026liver,
  title = {{Liver Transplantation for Alcohol-Related Liver Disease in 2026: Phenotypes, Selection, and Post-Transplant Care}},
  author = {Alberto Ferrarese and Giovanni Perricone and Laura Vivian and Alberto Zanetto and Guido Viel and Patrizia Burra and Alexandre Louvet and Giacomo Germani},
  journal = {Journal of Clinical Medicine},
  year = {2026},
  month = oct,
  doi = {10.3390/jcm15207840},
  url = {https://www.mdpi.com/2077-0383/15/20/7840},
  note = {CC BY 4.0},
}

RIS

TY  - JOUR
TI  - Liver Transplantation for Alcohol-Related Liver Disease in 2026: Phenotypes, Selection, and Post-Transplant Care
AU  - Alberto Ferrarese
AU  - Giovanni Perricone
AU  - Laura Vivian
AU  - Alberto Zanetto
AU  - Guido Viel
AU  - Patrizia Burra
AU  - Alexandre Louvet
AU  - Giacomo Germani
PY  - 2026
DA  - 2026/10/11
JO  - Journal of Clinical Medicine
DO  - 10.3390/jcm15207840
UR  - https://www.mdpi.com/2077-0383/15/20/7840
AB  - Liver transplantation (LT) for alcohol-related liver disease (ArLD) has evolved from a pathway centered on decompensated cirrhosis and prolonged abstinence to one that also encompasses severe alcohol-related hepatitis (sAH) and alcohol-related acute-on-chronic liver failure (ACLF). This change reflects the growing burden of ArLD and evidence that carefully selected patients with acute presentations can achieve excellent post-transplant survival. The traditional six-month abstinence rule has limited value as a stand-alone predictor of harmful post-transplant alcohol use. International guidance increasingly supports individualized multidisciplinary assessment of alcohol use disorder (AUD), psychiatric comorbidity, social vulnerability, insight, and treatment engagement, although listing requirements remain heterogeneous. Abstinence nevertheless remains a disease-modifying intervention that may promote clinical improvement, hepatic recompensation, and delisting in selected candidates. After LT, long-term care should integrate prevention and treatment of harmful alcohol use with surveillance and management of graft-related, cardiometabolic, oncologic, infectious, and other medical complications. This narrative Perspective critically appraises LT for ArLD in 2026 and proposes a phenotype-informed framework integrating medical urgency, dynamic reassessment, alcohol-use biomarkers, and longitudinal transplant–addiction care.
SN  - 2077-0383
ER  -