Liver transplantation is the gold standard treatment for terminal cirrhosis and liver cancer (if no surgical option is available). In France, the leading cause of liver transplantation is alcoholic cirrhosis. Severe alcohol relapse is often considered as a failure and concerns 11 to 26% of cases. The severe relapse causes a significant decrease in survival after 5 years of follow up, regardless of the origin of the transplantation. Predictors of relapse, like pretransplant abstinence duration, additional psychiatric co-morbidity, age, and level of social support have been assessed. However, alcohol addiction and liver transplantation are complex entities that cannot be reduced to a list of predictive factors. A multidisciplinary approach including an addiction specialist should identify and minimize the risk of severe relapse.