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February 23, 2022 CHANCE recruits over 100 patients In July 2021, Ef Clif’s largest observational prospective study was launched with the aim to compare the survival rates of patients with acute-on-chronic liver failure after liver transplantation and transplant-free survival. The CHANCE study has now recruited more than 100 patients.

BARCELONA—Acute-on-chronic liver failure (ACLF) is a syndrome that develops in 30% of the patients hospitalized due to cirrhosis. About 30% of patients with ACLF will die within 28 days of hospital admission. Pioneering studies by the European Foundation for the study of Chronic Liver Failure (EF Clif) have been of paramount importance in defining new criteria for the diagnosis and prognosis of ACLF and addressing the underlying mechanisms that contribute to acute hepatic decompensation, multiorgan failure, and high risk of short-term mortality.

Image: Number of patients recruited in North America, South America, Europe and Asia.

Although liver transplantation has been shown to be the most effective treatment for patients with ACLF grade 2-3 to date, with more than an 80% survival rate after 1 year of receiving a liver transplant (Belli et al., 2021), access to liver transplantation in some European countries is limited in treating patients with cirrhosis. In collaboration with the European Liver and Intestine Transplantation Society (ELITA) and the International Liver Transplantation Society (ILTS), EF Clif launched the CHANCE study, its largest prospective non-interventional observational global study in order to assess the survival rate of patients with cirrhosis who receive a liver transplant.

CHANCE – Liver transplantation in patients with cirrhosis and severe acute-on-chronic liver failure: Indications and outcomes – is a three-year study that will recruit 2000 patients from 93 hospitals in 29 countries around the globe, bringing together renowned surgeons, hepatologists, pathophysiologists, and researchers who are collaborating to collect and analyze patients’ clinical data and samples. CHANCE success very much relies on patient participation. More than 100 patients are now enrolled in the study.“Despite the global pandemic of COVID-19 and the regulatory challenges of a global study, the CHANCE study team and multiple outstanding investigators have accomplished a feat. We have just surpassed 100 patients enrolled. With new centers and active countries coming on board, we plan to accelerate enrollment to meet our goals”, said Thierry Gustot, Principal Investigator of the CHANCE study and Director of the Liver Transplant Unit at Erasmus Hospital and Senior Lecturer at Université libre de Bruxelles, Belgium.

The CHANCE study will contribute to the drafting of new protocols and standards for establishing the selection criteria for transplantation in patients with ACLF. The overarching aims of this study are to define better criteria for patient selection and make transplantation available to patients developing ACLF, a step forward towards harmonization across the world. “The results of this study are eagerly awaited in an attempt to resolve the inadequacies of the organ allocation rules for severe ACLF patients. With the multiple samples collected, we hope to explore the mechanisms responsible for the resolution of ACLF to open new therapeutic avenues”, explained Gustot.

List of CHANCE centers

Further reading

Belli, L.S.; Duvoux, D.; Artzner, T.; Arroyo, V.; Jalan, R.; for the ELITA/EF-CLIF working group. Liver transplantation for patients with acute-on-chronic liver failure (ACLF) in Europe: Results of the ELITA/EF-CLIF collaborative study (ECLIS). J. Hepatol. 2021, 75 (3), 610–620. DOI: 10.1016/j.jhep.2021.03.030


The European Foundation for the Study of Chronic Liver Failure (EF Clif) is a private nonprofit organization which mission is to promote research and education in hepatic chronic failure with the aim to contribute to improving the quality of life and to increase the survival of patients with liver cirrhosis. Since its foundation in 2009, the European Association for the Study of the Liver (EASL) Chair supports research activities through the EASL-Clif Consortium, a network of more than 100 European university hospitals and more than 300 clinical researchers. The Grifols Chair promotes translational studies across centers throughout Europe and North America within the framework of the European Network for Translational Research (ENTR) with 25 centers and more than 40 investigators.

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