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.