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Liver transplantation (LT) is the definitive treatment option for patients with end-stage liver disease and early hepatocellular carcinoma who meet the criteria established by various groups [1,2]. In selected cases, LT can also be considered for patients with giant hepatic hemangioma or hepatic epithelioid hemangioendothelioma [3,4]. Alcohol-associated liver disease (ALD) is one of the leading causes of LT worldwide. However, there is limited data on the characteristics of ALD patients across different centers and regions in Korea. Additionally, current strategies for managing ALD patients before and after LT are not well documented.

In this context, Choi et al. [5] investigated the characteristics of different centers and regional differences in ALD-LT by analyzing data from 19 centers across Korea. The authors effectively identified the rates of ALD-LT according to center and region. They demonstrated that approximately 20%–37% of patients undergoing LT were treated for ALD across centers, although some centers performed fewer ALD-LT cases compared to others. These findings were consistently observed across regions in Korea. This underscores the need for a comprehensive management strategy for patients undergoing ALD-LT.

This study also investigated the perioperative management protocols in Korea, including the alcohol abstinence period and treatment protocols for alcohol consumption. Interestingly, about half of the centers performing LT required a minimum alcohol abstinence period of 1–6 months before transplantation, and only 10%–20% of centers had formal management protocols for alcohol consumption either before or after LT. Indeed, pre-transplant abstinence and the risk of post-transplant alcohol relapse are critical considerations when performing LT in ALD patients, yet there is significant disparity in pre-transplant abstinence practices across regions and countries [2]. The recent guideline from Asian Pacific Association for Study of Liver suggest that while alcohol abstinence is preferable, the strict 3 to 6 months abstinence rule should be applied with a center-specific approach [2]. Moreover, considering that several guidelines have been proposed for the indication and post-transplantation management of patients with non-alcoholic fatty liver disease and de novo malignancy after LT [6-8], the development of nationwide management guidelines for ALD-LT is crucial to improve patient outcomes.

In conclusion, Choi et al. [5] effectively demonstrated the current varied strategies for ALD-LT in Korea. This study also highlights the need for developing consistent management guidelines for ALD-LT to improve outcomes for liver transplant patients in Korea.

This study received financial support of the Catholic Medical Center Research Foundation made in the program year of 2024 (SKL). This work was also supported by the technology innovation program (or industrial strategic technology development program) (20024163, development of microbiome-based treatment technology to improve the treatment and prognosis of liver transplant patients) funded by the Ministry of Trade, Industry & Energy (MOTIE, Korea) (SKL). This work was also supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (Ministry of Science and ICT, MSIT) (RS-2024-00451810).

Soon Kyu Lee is an editorial member of the journal but was not involved in the review process of this manuscript.