I always check the concentricity and square and they (Lakewood) are usually out of tolerance, but most people are luckier than me. Way back 50 years ago when I was still fooling with flathead V-8's, even with factory bellhousings let alone bellhousing adaptors it was standard procedure to check that. (It says so in the book!)
When I was young, everything worked perfectly, but as soon as I knew better things went south in a hurry! Of course you can install them anyway but "the problem" shows up inside the transmission. If the input shaft is "cocked" even slightly the mainshaft is not parallel with the countershaft, resulting in gear noise at best and serious wear problems at worst.