How do you decide between immediate liver transplant referral versus a time-limited “recompensation observation” period in patients with alcohol-related cirrhosis who present with a first decompensation and achieve early, verified abstinence?

It can be difficult to differentiate the two, so one never errs on the side of evaluating the patient for a transplant and then getting to know them and their support system a bit better. The more data and time you have to make such a decision, the better it is. Often, the natural history of the disease makes the decision for you if the patient develops severe clinical manifestations of their liver failure, thus leading them down the transplant road. Having the patient within a structured enviro...