Hepatology international · 2026

The Global ACLF Consensus : the 'Istanbul Document'.

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Kulkarni Anand V, Choudhury Ashok, Arora Vinod, Dokmeci Abdul Kadir, Koshy Abraham, Gurakar Ahmet, Duseja Ajay, Roy Akash, Shukla Akash, Krag Aleksander, Kow Alfred Wei Chieh, Shrestha Ananta, Kaewdech Apichat, Goel Ashish, Kumar Ashish, Singal Ashwani K, Bwa Aung Hlaing, Hongthanakorn Chanunta, Lesmana Cosmas Rinaldi Adithya, Huang Daniel, Crawford Darrell, Shawcross Debbie, Balchi Deniz, Agrawal Dhiraj, Payawal Diana A, Song Do Seon, Kim Dong Joon, Bessone Fernando, Lau George K, Germani Giacomo, Pati Girish Kumar, Su Grace L, Lee Guan-Huei, Adali Gupse, Szabo Gyongyi, Ghazinian Hasmik, George Jacob, Fung James, Bajaj Jasmohan, Javed P, Jia Jidong, Lai Jimmy Che-To, Chen Jin Jun, Trebicka Jonel, Li Jun, Patidar Kavish, Kalista Kemal Fariz, Liu Ken, Thanapirom Kessarin, Wei Lai, Azam M Golam, Premkumar Madhumita, Niriella Madunil, Alla Manasa, Pagadala Mangesh, Kumar Manoj, Mendizabal Manuel, Pessoa Mario Guimaraes, Muthiah Mark Dhinesh, Omata Masao, Noureddin Mazen, Karim Md Fazal, Sharma Mithun, Alboraie Mohamed, Elbasiony Mohamed, Harputluoglu Murat, Choudhary Narendra Singh, Selzner Nazia, Ormeci Necati, Hernandez Nelia, Verma Nipun, Angeli Paolo, Charatcharoenwitthaya Phunchai, Maji Prabir, Rathi Pravin, Dhiman R K, Kumar Rahul, Maiwall Rakhi, Idilman Ramazan, Moreau Richard, Gani Rino A, Mohamed Rosmawati, Hamid S S, Sachdeva Sanjeev, Kaur Senamjit, Alam Shahinul, Maung Soe Thiha, Tan Soek-Siam, Sowmya T R, Sudhamshu K C, Ramachandra Sumana, Dadhich Sunil Kumar, Taneja Sunil, Giri Suprabhat, Singh Surender, Chen Tao, Gupta Tarana, Madke Tushar, Dayal V M, Shantan Venishetty, Pamecha Viniyendra, Jun Wong Yu, Qi Xiaolong, Kim Yoon Jun, Abbas Zaigham, Younossi Zobair M, Sarin Shiv Kumar, APASL-ACLF Research Consortium (AARC) for APASL-ACLF working party

Аннотация

The Kyoto Consensus introduced a key conceptual shift in characterizing acute-on-chronic liver failure (ACLF) patients into Type-A and Type-B phenotypes. A day-long meeting was convened at Istanbul during APASL 2026 to assess the real-world applicability of Type-A and Type-B ACLF across continents. The objective was that physicians could recognize ACLF as a unified disease entity, and quality research and new therapeutic options with defined end-points could be undertaken. Data from APASL ACLF Research Consortium (AARC), EASL-CLIF and NACSELD were assessed and discussed in detail. While the applicability of Type-A and Type-B varied across cohorts, the definition required to be appended. The experts unanimously agreed that 'liver failure' as identified by serum bilirubin of ≥ 5 mg/dl and INR ≥ 1.5 should be the 'core' for both Type-A and Type-B ACLF. Type-A ACLF is considered when "a patient with compensated advanced chronic liver disease or compensated cirrhosis presents with index decompensation as liver failure followed by development of ascites and/or hepatic encephalopathy within 4 weeks." Type-B ACLF is considered when "a patient with prior or concurrent decompensated cirrhosis presents with acute decompensation as liver failure accompanied by one or more extrahepatic organ failures." New definitions of organ dysfunction and failure, as well as endpoints for clinical trials, were also deliberated and finalized. The "Istanbul Report", presents a milestone evidence based consensus document carrying harmonization of various aspects of ACLF, incorporating current evidence, critically analyzed unanimous recommendations, and key areas for future studies.

The Global ACLF Consensus : the 'Istanbul Document'.

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Аннотация