Over the past 15 years, opinion regarding the suitability of alcoholic patients for liver transplantation has fluctuated from overt disapproval to optimism that liver transplantation might have a beneficial effect on alcoholic behaviour. The former view was evaluated by an opinion survey among the general population, general practitioners and hospital specialists in Great Britain, in which the vignette of an alcoholic in need of liver transplant was consistently rated as justifying a low priority.1 The origin of optimism about the salutary effects of transplantation on alcoholic relapse came from Thomas Starzl, who coined the aphorism that, “liver transplantation was the ultimate sobering experience”.2The current status of liver transplantation for alcoholic liver disease rests somewhere between these two extremes.

Alcoholic liver disease is a common diagnosis among patients selected for liver transplantation in North America and Europe. It often occurs in conjunction with chronic hepatitis C infection. All transplant programmes try to identify patients who will remain abstinent, although how best to achieve this end is less certain. The study by Pageauxet al, in this issue (see page 421), is unusual in not including psychiatry as part of the pretransplant assessment.4 The requirement for a fixed period of abstinence, the so called …