Severe liver failure: transplantation offers a genuine chance of survival

A major difference in survival after transplantation

The CHANCE cohort includes more than 1,000 patients treated at 63 centres across Europe, North America, South America and Asia. The study results show a striking difference between patients who underwent transplantation and those who were unable to benefit from it. Among patients deemed unsuitable for transplantation, one-year mortality reached 73% in cases of ACLF-2 and 88% in cases of ACLF-3 (severe stage).

Among patients with comparable disease severity who underwent liver transplantation, mortality was 10.5% and 20.7%, respectively. These results show that, even in patients with very advanced cirrhosis, multiple organ failures and a potential need for organ-support therapies or life support, transplantation can offer a genuine prospect of long-term survival.

“ The CHANCE data show that the severity of ACLF should not, on its own, lead to transplantation being considered futile. For the vast majority of these patients, when transplantation can be performed under appropriate conditions and at the right time, it can transform an extremely poor prognosis into a genuine chance of survival,” explains Professor Thierry Gustot, Director of the H.U.B Transplantation Department and principal investigator of the CHANCE study.

Rethinking transplantation in severe ACLF

Until now, knowledge about transplantation in patients with severe ACLF has been based mainly on studies analysing data collected at a limited number of centres, sometimes within a single hospital or region. These studies provided valuable information, but involved relatively small groups of patients selected in specific settings, which could limit the generalisability of their findings. The CHANCE study offers a new perspective thanks to its prospective, international and multicentre design.

However, the study identifies one important limitation: in patients with five or six organ failures, outcomes after transplantation remain considerably less favourable. These data therefore call for particularly rigorous patient selection in this extreme situation. The challenge is to better identify, among the most severely affected patients, those who may still derive substantial benefit from transplantation and those for whom the risk of failure remains too high.

An international infrastructure to advance research

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

“ CHANCE is not merely a clinical study. We have established an international cohort and biobank that will allow us to explore new questions in the years to come: why do some patients recover after transplantation while others deteriorate? Which markers could help us select candidates more effectively? And how can we intervene earlier? ,” emphasises Professor Gustot.

The Hepatology Clinic and the Liver Transplantation Medical Clinic provide care for all patients with acute or chronic, common or rare liver disease, screen for liver diseases and assess their severity, and care for patients who are candidates for liver transplantation, as well as patients undergoing post-liver transplantation follow-up.

Brussels University Hospital is a referral centre for the management of liver diseases, with comprehensive expertise and diagnostic and therapeutic resources. It is one of the six liver transplantation centres in Belgium.