Acute-on-chronic liver failure: a global multisociety consensus on definitions
The acute-on-chronic liver failure (ACLF) multisociety harmonisation initiative represents a global collaborative effort to establish a unified, evidence-based framework for the definition, diagnosis, grading, and management of ACLF. Building on the strengths of existing regional definitions and integrating diverse international perspectives, this consensus provides a pragmatic, globally applicable foundation for clinical practice, research, and education. It also establishes a common framework for patient stratification, organ dysfunction and failure assessment, critical care management, liver transplantation, and the design of future phase II/III trials. Standardised, regulatory-aligned endpoints are expected to improve cross-study comparability, strengthen collaboration, and accelerate development of effective ACLF therapies.
Authors
- Victoria Mainardi (ORCID: https://orcid.org/0000-0002-5443-5531)
- Richard Moreau (ORCID: https://orcid.org/0000-0003-0862-403X)
- Yvonne Nartey (ORCID: https://orcid.org/0000-0001-9876-679X)
- Vinay Jahagirdar (ORCID: https://orcid.org/0000-0001-6685-1033)
- Paolo Angeli (ORCID: https://orcid.org/0000-0002-1913-0716)
- Julia Alexis Wendon (ORCID: https://orcid.org/0000-0003-0226-6366)
- Gabriel Mezzano P. (ORCID: https://orcid.org/0000-0003-0166-4362)
- Marta Tonon (ORCID: https://orcid.org/0000-0001-8913-0992)
- Javier Fernández (ORCID: https://orcid.org/0000-0002-5622-0489)
- C Wendy Spearman (ORCID: https://orcid.org/0000-0003-3199-301X)
- Baila R. Elkin (ORCID: https://orcid.org/0000-0001-6211-0297)
- Shiv Kumar Sarin (ORCID: https://orcid.org/0000-0002-0544-5610)
- Jonel Trebicka (ORCID: https://orcid.org/0000-0002-7028-3881)
- Rubén Hernáez (ORCID: https://orcid.org/0000-0002-1518-4020)
- Hasmik Ghazinian
- Michael Ronan Lucey (ORCID: https://orcid.org/0000-0002-0380-7980)
- Christina C. Lindenmeyer (ORCID: https://orcid.org/0000-0002-9233-6980)
- Ashok Kumar Choudhury (ORCID: https://orcid.org/0000-0001-6540-2623)
- Amna Subhan
- Mark Wayne Sonderup (ORCID: https://orcid.org/0000-0001-7128-8329)
- Sebastián Marciano (ORCID: https://orcid.org/0000-0002-7983-1450)
- Alberto Farías (ORCID: https://orcid.org/0000-0002-2625-9921)
- Jacqueline G. O’Leary (ORCID: https://orcid.org/0000-0003-3640-4851)
- Nabil Debzi (ORCID: https://orcid.org/0000-0003-0842-1582)
- Christophe Moreno (ORCID: https://orcid.org/0009-0001-5305-2483)
- Ponsiano Ocama (ORCID: https://orcid.org/0000-0002-6120-1055)
- Alberto Queiróz Farias (ORCID: https://orcid.org/0000-0002-5572-663X)
- Leyla Nazal
- Kessarin Thanapirom (ORCID: https://orcid.org/0000-0003-2333-1702)
- Qin Ning (ORCID: https://orcid.org/0000-0002-2027-9593)
- Jacob George (ORCID: https://orcid.org/0000-0002-6592-3215)
- Graciela Elia Castro
- Constantine Karvellas
- Mohammed El-Kassas
- Jasmohan S. Bajaj (ORCID: https://orcid.org/0000-0003-4928-3681)
- Adriana Varon
- Debbie L. Shawcross
- Elizabeth Gatley
- Society on Liver Disease in Africa (SOLDA)
- Amanjot Kaur Bahri
- Alice Kerkham
- Angelo Mattos
Institutions
- Virginia Commonwealth University (US)
- Virginia Commonwealth University Medical Center (US)
Publication Details
- Journal
- Hepatology International
- Published
- 2026-10-30
- DOI
- https://doi.org/10.1007/s12072-026-11169-2
- Primary Topic
- Liver Disease and Transplantation
- Type
- article
- Field-Weighted Citation Impact
- 0.00
Funders
- American Association for the Study of Liver Diseases
- European Association for the Study of the Liver