Improving survival rates for patients with chronic liver failure

12 October 2026 - Professor Will Bernal was Co-Chief Investigator in the CHANCE study

William Bernal, a Professor of Liver Critical Care at the Institute of Liver Studies at King’s College Hospital NHS Foundation Trust, has contributed to a major study that could save the lives of patients with acute-on-chronic liver failure (ACLF).

Acute-on-chronic liver failure is a rapid and severe worsening of chronic liver disease or cirrhosis that causes organ failure and high short-term mortality.

The CHANCE study is the first global prospective study of the impact of liver transplantation on ACLF outcomes.

The research findings, recently published in the Journal of Hepatology, collated survival outcomes from over 900 patients with ACLF at 63 liver transplant centres across Asia, Europe, Latin America and North America.

Researchers found that after liver transplantation, around 90% of patients with ACLF-2 (the less severe form of the condition) and 80% of patients with ACLF-3 (the more severe condition) survived for at least one year following their operation.

In contrast, when not offered liver transplantation, only 27% of ACLF-2 and 12% of ACLF-3 patients survived for a year.

The findings point towards a more individualised assessment of patients with the most severe forms of ACLF, based on the number and type of organ failures, rather than on ACLF grade alone.

Professor Bernal said: “Until recently, patients with ACLF were rarely considered for a liver transplant because of how suddenly and rapidly they become severely ill. Patients with ACLF often quickly became too ill to survive a transplant, or died before a suitable donor could be found.

“These latest findings build on research led by King’s in 2024, where for the first time, critically ill patients with ACLF were prioritised in a planned national transplant programme. The CHANCE study has now confirmed that, for selected patients with very severe ACLF, we now have a treatment option that is both practical and lifesaving.

“These latest findings will help us to identify the patients most likely to benefit from liver transplant, so that we can most effectively use the limited number of donations available.”

The resulting dataset and biobank from the CHANCE study will provide a foundation for further research studies, as well as providing transplant teams around the world with evidence to help assess patients with severe forms of ACLF, identifying those most likely to benefit from liver transplantation.

For more information about the CHANCE study, visit: https://www.journal-of-hepatology.eu/article/S0168-8278(26)02908-9/fulltext