Survival outcomes after liver transplantation in acute-on-chronic liver failure: A prospective study.

Liver transplantation significantly improves one-year survival in patients with ACLF-2 and ACLF-3 compared to those who are declined, with 88% mortality in ACLF-3 patients declined for transplant.

• Why it matters: Understanding the survival benefit of liver transplantation in advanced ACLF is crucial for guiding treatment decisions and resource allocation, especially given the high mortality among patients declined for transplant.
• What they did: A prospective study enrolled 756 adults with decompensated cirrhosis and ACLF grades 1-3 across 63 centers from 2021 to 2023, tracking outcomes for one year, including 144 patients declined for LT and 612 who received transplants.
• The result: Patients with ACLF-3 had a 42% case-fatality rate when having five or six organ failures, while post-LT mortality was higher in Asia and among ACLF-3 patients, with 21% overall mortality without re-transplantation, indicating better survival with transplantation but cautioning against routine LT in those with extensive organ failure.