Severe alcoholic hepatitis (AH) presents as decompensated liver disease in persons who drink excessive amounts of alcohol. There is a wide dose-response to the toxic effects of alcohol. Approximately 20% of individuals who consume 60 grams of alcohol or more on a regular daily basis for 20 or more years have been observed to develop clinical liver disease, although many women who drink less also will exhibit signs and symptoms of the disorder. Severe AH should be thought of as a form of acute-on-chronic liver failure, because of the latent presence of variable amounts of fibrosis and inflammation in affected individuals. The clinical presentation, therefore, may be any combination of liver-decompensation syndromes including, but not limited to, hepatitis with jaundice and coagulopathy, portal-hypertensive bleeding, hepatic encephalopathy, hepatorenal syndrome, and ultimately progression to multi-organ failure. Mortality depends on the stage of underlying fibrosis and the degree of inflammation, and may be as high as 70%. Thus, it is understandable that affected patients have been treated with varying degrees of success, mainly with steroids; nonresponse to medical therapy is associated with a six-month survival of approximately 30%.