<P> The effects of anti--tumor necrosis factor medications such as infliximab and etanercept are unclear and possibly harmful . Evidence is unclear for pentoxifylline . Propylthiouracil may result in harm . </P> <P> Evidence does not support supplemental nutrition in liver disease . </P> <P> Although in rare cases liver cirrhosis is reversible, the disease process remains mostly irreversible . Liver transplantation remains the only definitive therapy . Today, survival after liver transplantation is similar for people with ALD and non-ALD . The requirements for transplant listing are the same as those for other types of liver disease, except for a 6 - month sobriety prerequisite along with psychiatric evaluation and rehabilitation assistance (i.e., Alcoholics Anonymous). Specific requirements vary among the transplant centers . Relapse to alcohol use after transplant listing results in delisting . Re-listing is possible in many institutions, but only after 3--6 months of sobriety . There are limited data on transplant survival in patients transplanted for acute alcoholic hepatitis, but it is believed to be similar to that in nonacute ALD, non-ALD, and alcoholic hepatitis with MDF less than 32 . </P> <P> The prognosis for people with ALD depends on the liver histology as well as cofactors, such as concomitant chronic viral hepatitis . Among patients with alcoholic hepatitis, progression to liver cirrhosis occurs at 10--20% per year, and 70% will eventually develop cirrhosis . Despite cessation of alcohol use, only 10% will have normalization of histology and serum liver enzyme levels . As previously noted, the MDF has been used to predict short - term mortality (i.e., MDF ≥ 32 associated with spontaneous survival of 50--65% without corticosteroid therapy, and MDF <32 associated with spontaneous survival of 90%). The Model for End - Stage Liver Disease (MELD) score has also been found to have similar predictive accuracy in 30day (MELD> 11) and 90 - day (MELD> 21) mortality . Liver cirrhosis develops in 6--14% of those who consume more than 60--80 g of alcohol daily for men and more than 20 g daily for women . Even in those who drink more than 120 g daily, only 13.5% will suffer serious alcohol - related liver injury . Nevertheless, alcohol - related mortality was the third leading cause of death in 2003 in the United States . Worldwide mortality is estimated to be 150,000 per year . </P>

The type of alcoholic liver disease that is not reversible is
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