The CHANCE study aims to recruit 2000 patients by the end of 2023. With 58 actively recruiting centers in 20 countries across the world, we are confident that CHANCE will render positive results and provide answers to our primary objective: To compare 1-year graft and patient survival rates after liver transplantation in patients with acute-on-chronic liver failure (ACLF) grade 2 or 3 at the time of liver transplantation with patients with decompensated cirrhosis without ACLF and transplant-free survival of patients with ACLF grade 2 or 3 not listed for liver transplantation.