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

Liver transplantation significantly improves survival in patients with severe ACLF, with a 21% case-fatality rate for ACLF-3 at one year, but high risk persists for those with five or six organ failures.

• Why it matters: Understanding the survival benefits of liver transplantation in advanced ACLF is crucial for guiding treatment decisions and resource allocation, especially given the high mortality rates in patients declined for transplant.
• What they did: A prospective study enrolled 756 adults with decompensated cirrhosis across 63 centers, comparing outcomes of those who received liver transplants versus those who were declined, with follow-up over one year.
• The result: Patients with ACLF who underwent transplantation had markedly better survival than those declined, though those with extensive organ failures faced high post-transplant mortality, emphasizing cautious candidate selection.