The degree of liver damage related to alcohol can definitely vary person to person, and probably has a genetic component to it. Just like some people can smoke their whole life and not get lung cancer, some people can drink and not develop cirrhosis (I don't recommend anyone try this). Those cases are the exception to the rule. Smoking and alcohol generally have a dose dependent insult to the respective organs.But definitely have seen early 20s in full liver failure and die, related to alcohol. Some might argue that the developing liver during childhood are more prone to alcohol-related damage.Wow you and your family are really having a terrible month. You seem very calm and reasoned despite the fear and chaos going on. In any family facing these kinds of ordeals it is always very helpful to have someone like you who can rationally absorb information and help others understand.Things that you should "go to the ER now" for would be an altered mental status to the point of near unconsciousness even when you try and speak to her, unbearable pain that is worsening, fevers, significant breathing difficulty (a very rapid respiratory rate like 30+ times per minute or otherwise looks like she is "getting tired" of breathing), a rapid expansion of her swollen belly, or if she cannot do simple tasks of daily living like drinking water or using the restroom on her own. If she is not quite that bad I think it is likely safe to take her to dialysis tomorrow. The dialysis nurses will have a keen eye for patients who are too sick to be at the outpatient center, if they don't seem particularly concerned about her and she tolerates dialysis well then I think she can go back home and await the hepatology appointment / video call on Wednesday. Hopefully you will have much more information after that and can then come up with a plan for the future.Patients with alcoholic liver disease do indeed received transplants all the time. Just because she was not a candidate once does not necessarily mean she never will be. For liver failure caused by alcohol or drug abuse, most donor networks will require abstinence for some period of time (usually several months at a minimum)... but it also sounds like she needs quite a bit of "medical optimization" before she would be well enough to undergo a liver transplant anyway. She needs to recuperate and heal from her infection more and keep taking all the liver failure medications they prescribe. They may also be waiting for her kidneys to hopefully recover some. Hopefully in another week or two she is feeling a bit better and stronger... once she is able to she should strongly consider some kind of addiction recovery program (there are many free ones as well as ones covered by most insurance companies).My very best to her and your family.
Not the OP but have seen plenty of cases of 'young' alcoholics with severe or fulminant liver failure. I've also seen plenty of much older alcoholics who don't develop any of the usually associated diseases. It's a bit unpredictable but generally someone who develops severe disease at a young age will have been drinking a very significant amount over a sustained period of time. And some people are particularly vulnerable to disease unfortunately.