Press release

Severe liver failure: a transplant offers a real chance of survival

02/10/2026

Brussels, 2 October 2026 – For the first time, a large-scale international prospective study ,published in the Journal of Hepatology, directlycompares the outcomes of patients with severe liver failure (Acute-on-Chronic Liver Failure – ACLF), with and without a liver transplant.

A significant difference in survival following transplantation

The CHANCE cohort comprises more than 1,000 patients treated at 63 centres across Europe, North America, South America and Asia. The study’s results reveal a striking difference between patients who underwent a transplant and those who were unable to undergo one. Among patients who were deemed unsuitable for a transplant, the one-year mortality rate was 73 per cent for ACLF-2 and 88 per cent for ACLF-3 (severe stage). Among patients with a comparable severity of the condition who had undergone a liver transplant, these mortality rates were 10.5 per cent and 20.7 per cent respectively. These results demonstrate that, even in patients with very advanced cirrhosis who are suffering from multiple organ failure and may require replacement therapies or life support, transplantation can offer a realistic prospect of long-term survival.

“The CHANCE data show that the severity of ACLF alone should not be a reason to regard transplantation as futile. For the vast majority of these patients, a transplant – when carried out under the right conditions and at the right time – can turn an extremely bleak prognosis into a realistic chance of survival”, explains Prof. Thierry Gustot, director of the Transplantation Department at the H.U.B and principal investigator of the CHANCE study.

A new perspective on transplantation in severe ACLF

Until now, knowledge about transplantation in patients with severe ACLF has been based mainly on studies analysing data collected in a limited number of centres, sometimes within a single hospital or a single region. This research provided valuable information, but related to relatively small groups of patients selected in specific contexts, which could have limited the scope of the results. The CHANCE study offers a new perspective thanks to its prospective, international and multicentre nature. However, the study highlights a significant limitation: in patients with five or six organ failures, post-transplant outcomes remain considerably less favourable. These findings therefore argue for particularly careful patient selection in this extreme situation. The challenge, therefore, lies in better distinguishing, amongst the most severely affected patients, those who can still derive significant benefit from a transplant and those for whom the risk of failure remains too high.

An international infrastructure to continue the research

The ambition of the CHANCE study extends beyond the results of this initial publication. The study is based both on a detailed follow-up of the patients’ clinical course and on a biobank containing samples collected during their treatment: blood, plasma, urine and DNA. This infrastructure, established across the 63 participating centres worldwide, thanks to the support of the European Foundation for Chronic Liver Failure (EF-Clif), constitutes a unique scientific resource for better understanding the mechanisms of ACLF, identifying the factors associated with the response to transplantation and, in the long term, improving patient selection and treatment.

“CHANCE is not just a clinical trial. We have built up an international cohort and a biobank that will enable us to investigate new questions in the coming years: why do some patients recover after a transplant, whilst others have an unfavourable outcome? Which markers could help us select candidates more effectively? And how can we intervene earlier? ”, emphasises Prof. Gustot.