AbstractAlcoholic liver disease is the most common reason for transplantation. Despite a growing body of substance abuse references in the transplant literature, there are none on the comorbidity of eating disorders and alcoholism. We present a case example that demonstrates the complex and serious nature of comorbid anorexia nervosa and alcoholism. The unfortunate outcome highlights the need to address not only current behaviors that lead to liver failure, such as alcoholism, but also previous coping behaviors, such as anorexia, that may reemerge if the patient regresses under extreme perioperative stress.