Background and Aims: Alcohol-associated liver disease (ALD) is a leading indication for liver transplantation (LT), and many ALD recipients present with substantial physiologic acuity, renal dysfunction, and infectious risk. Tacrolimus initiation is often delayed in this setting to limit nephrotoxicity or avoid intensifying active infection, but the clinical consequences remain incompletely defined. We evaluated whether delayed tacrolimus initiation after LT was associated with biopsy-proven acute rejection (BPAR), infectious complications, graft loss, and mortality within 12 months after transplant. Methods: We performed a single-center retrospective cohort study of adult deceased-donor LT recipients transplanted for ALD at Virginia Commonwealth University Health System between November 1, 2015 and July 31, 2023. The primary exposure was tacrolimus initiation timing: early (detectable by day 7) versus delayed (after day 7). The primary endpoint was BPAR within 12 months. Secondary endpoints included CMV DNAemia, bloodstream infection, graft loss, and mortality. To address confounding by indication, we performed propensity score matching (1:1 nearest neighbor) based on pre-transplant illness severity. Sensitivity analyses included multivariable Cox regression and stratification by MELD-Na category. Results: Among 284 included recipients, 189 (67%) had early initiation and 95 (33%) had delayed initiation. Propensity score matching produced 82 well-balanced pairs. In the matched cohort, delayed tacrolimus initiation remained associated with significantly higher BPAR (39% vs 16%, p=0.001; adjusted HR = 2.84, 95% CI 1.58–5.12, p<0.001). CMV DNAemia (30% vs 18%, p=0.04) and bloodstream infection (24% vs 12%, p=0.03) were also higher in the delayed group. Delayed initiation was associated with increased graft loss (HR = 2.21, 95% CI 1.12–4.36, p=0.02) and all-cause mortality (HR = 2.34, 95% CI 1.14–4.81, p=0.02) in Cox regression. Results were consistent across sensitivity analyses. Conclusions: Among LT recipients with ALD, delayed tacrolimus initiation beyond post-transplant day 7 was associated with higher risk of BPAR, CMV DNAemia, bloodstream infection, graft loss, and mortality, even after rigorous adjustment for confounding by indication. These findings suggest that when clinically feasible, minimizing tacrolimus delay may improve outcomes, and that delayed initiation should prompt heightened surveillance for rejection and infection.