Letter of the president

2020 has been a terrible year for the Humanity because of the Covid2019 Pandemic. This introductory letter describing the activities of EFClif within this year, however, is a clear exponent of the human ability to adapt to extreme circumstances. Working remotely, outside the EFClif headquarters, we have been able to finalise the ACLARA study, which included 1,245 patients hospitalized with acute decompensation of cirrhosis hospitalized in more than 40 hospitals from seven Latin-American countries (Mexico, Colombia, Perú, Brazil, Argentina, Paraguay, and Chile). We revised hundreds of thousands of clinical and standard laboratory data, closing the final clinical database, and successfully initiated the complex process of importing several thousands of biological samples that will help to understand the behaviour of the acute-on-chronic Liver failure (ACLF) in the Central and South Latin-American Area. The ACLARA study is also important because it will also introduce the first concepts on the role of ethnicity in the prevalence and severity of the syndrome. I am extremely grateful to the hundreds of researchers (nurses and physicians) from the Latin-American CLIF Consortium participating in the study and to the components of the ACLARA study office in the Hospital das Clinicals in Sao Paulo for their excellent work.

2020 has been also the year of launching the organization the CHANCE study, which is aimed to assess the role of liver transplantation in the management of ACLF. The study is a joint venture of EFClif, the European Liver and Intestine Transplant Association (ELITA) and the International Liver Transplant Society (ILTS). The CHANCE study will represent a major challenge for EFClif, since it plans to include 3000 patients that will be transplanted in 95 hospitals from Europe, North and South America, Asia, and Oceania. After the initial study recently accepted for publication by EFClif reporting excellent survival rates in CANONIC study patients with ACLF 2 and 3 treated by liver transplantation, an increasing number prospective and retrospective studies from Europe and USA have confirmed our observation. However, the indication of Liver transplantation is still extremely heterogeneous among different transplant units, with many of them considering patients with ACLF as being too ill for such a complex surgical procedure. It is, therefore, time to develop a definitive prospective study that stablish clear indications and futility criteria of liver transplantation in these patients. The CHANCE study will start including patients in May 2021, with only 4 months delay over the expected time.

Finally, 2020 has been a fruitful year for the scientific production of EFClif. Eighteen articles, including nine original research articles, were published. We are still publishing studies derived from the CANONIC study, our first large-scale multicentre investigation initiated in 2009. However, in 2020 we already published our first two articles derived from the PREDICT study, ensuring a second wave of important publications.

All these scientific activities, within a context of extremely severe emotional and logistic difficulties, would have been impossible without the enthusiasm of our investigators from the European and Latin-American CLIF Consortiums and the staff of EFClif in Barcelona. I am proud of them.