our results, that the disease susceptible ESR1 c.453-397 C allele had much stronger transcription activity than c.453-397 T allele, might suggest the liver failure risked c.453-397 C allele amplifies ESR1 transcription and probably produces more variant ESR1 isoforms compared with c.453-397 T allele. This evidence concerns the gene ESR1 and liver failure.