{
  "abstract": "Background and aims Liver transplantation (LT) is increasingly performed in the setting of acute-on-chronic liver failure (ACLF). In this context, pre-transplant evaluation must be completed rapidly while minimizing the risk of overlooking contraindications. We aimed to describe current practices for pre-transplant assessment in ACLF patients. Materials and Methods We conducted a survey across 34 European LT centers (including 16 French) and 22 French non-LT centers to assess pre-transplant evaluation practices, focusing on cardiopulmonary, addiction, oncological, and nutritional assessments. Practices were compared across three clinical scenarios: outpatients (OutPat), hospitalized decompensated patients without ACLF (Hosp), and ACLF patients admitted to intensive care units (ACLF-ICU). In parallel, we retrospectively evaluated post-transplant outcomes in patients with cirrhosis and severe ACLF transplanted in two high-volume centers. Results Fifty-three centers (96%) responded. Cardiological stress testing was reported in 2% of ACLF-ICU patients vs. 21% of OutPat (p=0.002) vs. 17% of Hosp patients (p=0.008). Coronary angiography following abnormal noninvasive testing was less frequently performed in ACLF (42%) than in OutPat (76%, p=0.0004) or Hosp patients (66%, p=0.01). Alcohol abstinence requirements were more often decided on a case-by-case basis in ACLF (62%) than in OutPat or Hosp patients. Oncological screening, including colonoscopy and ENT consultation, was also less frequently performed in ACLF-ICU patients. Median time from assessment initiation to listing was 7 days in ACLF-ICU versus 45 days in OutPat and 18 days in Hosp patients (both p<0.0001). In the retrospective cohort (n=221), patients listed after ACLF onset had a higher 1-year incidence of cardiovascular events than those listed before ACLF onset (19% vs. 9%). Conclusion In ACLF-ICU patients, pre-transplant evaluation is markedly abbreviated, with critical gaps—particularly in cardiological assessment—highlighting the need for dedicated, evidence-based guidelines. Impact and implications We sent a questionnaire to centers with an expertise in the management of patients with ACLF to assess current practices in pre-transplant evaluation in patients with ACLF admitted in intensive care unit, as compared to patients without (outpatients and patients hospitalized in regular ward) According to the responses from 53 centers, cardiological stress test and coronary angiography were less commonly performed as part as pre-transplant evaluation in patients with ACLF admitted to the ICU, as well as colonoscopy and Ear Nose Throat consultation. Median timeframe from pre-LT workup initiation to listing was 7 days in patients with ACLF admitted to the ICU, which was significantly shorter than in patients without ACLF. These results suggest that pre-transplant workup is abbreviated in patients with ACLF, and might have an impact on post-transplant outcome, especially cardiovascular complications. Further dedicated studies are needed to specifically address the relation between pre-transplant workup and post-LT complications in patients with ACLF.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": null,
  "arxiv": null,
  "author_total": 57,
  "authors": [
    {
      "name": "Claire Bellec"
    },
    {
      "name": "Anea Augé"
    },
    {
      "name": "Sébastien L’hermite"
    },
    {
      "name": "Romain Moirand"
    },
    {
      "name": "Armand Abergel"
    },
    {
      "name": "Matthew Amstrong"
    },
    {
      "name": "Teresa Antonini"
    },
    {
      "name": "Rodolphe Anty"
    },
    {
      "name": "Marion Khaldi"
    },
    {
      "name": "Aurore Baron"
    },
    {
      "name": "Mouni Bensenane-Oussalah"
    },
    {
      "name": "William Bernal"
    },
    {
      "name": "Christophe Bureau"
    },
    {
      "name": "Nicolas Carbonell"
    },
    {
      "name": "Jean-François Cadranel"
    },
    {
      "name": "Filipe Cardoso"
    },
    {
      "name": "Paul Carrier"
    },
    {
      "name": "Audrey Coilly"
    },
    {
      "name": "Isabel Conde"
    },
    {
      "name": "Filomena Conti"
    },
    {
      "name": "Agnes Bonadona"
    },
    {
      "name": "Gonzalo Crespo"
    },
    {
      "name": "Sarwa Darwish Murad"
    },
    {
      "name": "Sébastien Dharancy"
    },
    {
      "name": "Christophe Duvoux"
    },
    {
      "name": "Cornelius Engelmann"
    },
    {
      "name": "François Faitot"
    },
    {
      "name": "Claire Francoz"
    },
    {
      "name": "Armand Garioud"
    },
    {
      "name": "René Gerolami"
    },
    {
      "name": "Elia Gigante"
    },
    {
      "name": "Odile Goria"
    },
    {
      "name": "Thierry Gustot"
    },
    {
      "name": "Brian Hogan"
    },
    {
      "name": "Ludovic Lagin"
    },
    {
      "name": "Adrien Lannes"
    },
    {
      "name": "Marianne Latournerie"
    },
    {
      "name": "Victor de Ledinghen"
    },
    {
      "name": "Giulia Magini"
    },
    {
      "name": "Martin Mateo"
    },
    {
      "name": "Arnaud Maurin"
    },
    {
      "name": "Manuela Merli"
    },
    {
      "name": "Magdalena Meszaros"
    },
    {
      "name": "Georges-Philippe Pageaux"
    },
    {
      "name": "Claire Perignon"
    },
    {
      "name": "Giovanni Perricone"
    },
    {
      "name": "Michael Praktiknjo"
    },
    {
      "name": "Noemi Reboux"
    },
    {
      "name": "Thomas Reiberger"
    },
    {
      "name": "Valentin Rolle"
    },
    {
      "name": "Isabelle Rosa"
    },
    {
      "name": "Ruxandra Sarba"
    },
    {
      "name": "Faustine Wartel"
    },
    {
      "name": "Delphine Verhoeven Weil"
    },
    {
      "name": "Alberto Zanetto"
    },
    {
      "name": "Laure Elkrief"
    },
    {
      "name": "Florent Artru"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/9vzr4ffhkds8x.bib",
  "cited_by": 0,
  "doi": "10.1016/j.jhepr.2026.101794",
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  "id": "9vzr4ffhkds8x",
  "issns": [
    "2589-5559"
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  "landing_url": "https://hal.science/hal-05549742v1",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
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  "pdf_url": "https://hal.science/hal-05549742/document",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-13",
  "publisher": "Elsevier",
  "ris": "https://research.draconitic.com/paper/9vzr4ffhkds8x.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:55Z",
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  "title": "Pre-liver transplant assessment of patients with acute-on-chronic liver failure: an international survey",
  "title_text": "Pre-liver transplant assessment of patients with acute-on-chronic liver failure: an international survey",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:17:55Z",
  "url": "https://research.draconitic.com/paper/9vzr4ffhkds8x",
  "venue": "JHEP Reports  Innovation in Hepatology",
  "versions": []
}