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Acute-on-chronic liver failure is a cause of decompensation of liver cirrhosis and an indication for liver transplantation, however there are no data about its prevalence in the Internal Medicine Departments and in the Transplant Centers of Lazio. From the ECLIS study it appears that in Italy out of 7 Centers with 359 transplants for Decompensated Cirrhosis, 49 were for ACLF 2-3 (13.6%). To collect data of Lazio, a questionnaire was submitted to the Internal Medicine Departments and a letter sent to the Transplant Centers of Rome. A 22-items on-line questionnaire (Google Forms), discussed within the hepatology area of ​​FADOI Lazio, was administered from 01/02/2024 to 01/04/2024 to the medical departments of Lazio. 15 Depts responded, for 80 % of them decompensated cirrhosis represented 3-8% of the total diagnosis. For 60% etiology was alcoholic in 30-50% of cases, for 60% was Metabolic in 10-30%, for 53.3% was viral in <10%, for 92.9% was autoimmune in <10%, for 73,3% was unknown in <10%. 20-50% of patients admitted for acute decompensation met the EASL-CLIF criteria of ACLF. Patients discharged/transferred to a transplant department varied from center to center (range 20-80%), like patients sent to palliative care or who have died. The primary cause of ACLF was > 1 factor in 46.7% of cases, alcohol abuse in 33%, bacterial infections in 13.3%. Data from the transplant centers are as follows: Policlinico Umberto I from 2013 to 2024 had had 12/251 (4.8%) transplants for ACLF, Policlinico Tor Vergata in the last 4 years 3/140 (2.1%), San Camillo Hospital in the last 5 years 55/397 (13.8%). The data collected will serve to improve the questionnaire to be presented as a national survey. Data from the Transplant Centers varied from center to center and were not comparable due to the different observation periods. [ABSTRACT FROM AUTHOR]