Immune checkpoint inhibitors (ICIs) have reshaped the treatment paradigm of hepatocellular carcinoma (HCC), delivering improvements in tumor responses and survival benefits in those with advanced disease. Simultaneously, liver transplantation remains the most effective curative strategy for selected perons with HCC. As immunotherapy is increasingly considered a primary strategy or in combination with locoregional therapy (LRT) for bridging or downstaging to transplantation, clinicians are confronted with a fundamental and unresolved clinical question: Should immunotherapy be routinely incorporated into transplant pathways or are established locoregional approaches sufficient for most candidates? 

This session utilizes a structured pro-con discussion examining whether immunotherapy should be routinely incorporated as a primary or adjunctive bridging/ downstaging strategy, or whether LRT alone remains sufficient in most transplant candidates. Through interactive, case-based discussion, the presenters aim to provide a pragmatic framework for multidisciplinary, patient-centered decision-making in one of the highest stakes scenarios in contemporary hepatology. Presenters explicitly address unresolved and controversial questions, including:

• Should immunotherapy be routinely used as a primary or adjunctive bridging/downstaging therapy in transplant-eligible patients with HCC, or is locoregional therapy alone adequate?
• Rejection or recurrence: Which risk should weigh more in transplant decision-making?
• For how long is it worthwhile to treat with immunotherapy in the pretransplant setting?
• What is the optimal washout period before transplantation? Is a universal threshold realistic?
• Should deep or durable responses to immunotherapy alter transplant candidacy or timing?
• How should immunosuppression be managed in patients previously exposed to ICIs? 

Learn from the experts in this practical, case-based discussion regarding the diagnosis and management of complex liver allograft rejection. Faculty focus on real-world scenarios including antibody-mediated rejection, steroid-resistant T cell-mediated rejection, plasma cell–rich rejection, and chronic rejection. Attendees participate in an informative interactive discussion and learn management pearls for challenging rejection cases. 

Part 1: Liver Fat Comes Out of the Shadows—Transforming Care in Steatotic Liver Disease
Steatotic liver disease now represents the most prevalent spectrum of liver disorders encountered in clinical practice worldwide. Rapid advances in disease nomenclature, epidemiology, pathophysiology, and therapeutics have fundamentally changed how clinicians evaluate and manage these patients. Presenters review the evolving natural history and global burden of steatotic liver disease with a focus on metabolic dysfunction–associated and alcohol-associated liver disease. Faculty translate emerging evidence into practical strategies for risk stratification, treatment selection, and longitudinal management, including referral considerations for liver transplantation. The session concludes with interactive, board-style questions designed to reinforce key concepts and highlight common clinical pitfalls.

Part 2: The Many Ways the Liver Fails—Contemporary Approaches to Decompensation and Failure
Liver failure encompasses a diverse set of clinical syndromes with significant morbidity and mortality. Presenters explore recent advances in understanding the dynamic processes of hepatic decompensation and recompensation. Expert faculty address evidence-based approaches to managing the major complications of portal hypertension—including ascites, variceal bleeding, and hepatic encephalopathy—as well as emerging insights into noncirrhotic portal hypertension. The session concludes with a modern framework for evaluating and managing acute liver failure and acute-on-chronic liver failure, supported by interactive, board-style questions to consolidate learning.

Part 3: We Have a Medicine for That—Navigating Therapeutic Advances in Liver Disease
The pace of therapeutic innovation in hepatology continues to accelerate, creating both opportunity and complexity for practicing clinicians. Presenters focus on areas with the most transformative recent advances and highest impact on patient outcomes. Topics include: contemporary management of chronic cholestatic liver disease; advances in antiviral therapy for hepatotropic viral infections; optimization of renal function and fluid balance in persons with cirrhosis; and evolving systemic and locoregional therapies for liver-related malignancies. Interactive, board-style questions are utilized to emphasize clinical decision-making and guideline-concordant care.

Part 4: Not Every Fix Is a Pill—Innovations Redefining Hepatology Practice
Some of the most impactful advances in hepatology extend beyond pharmacotherapy. Faculty for this forward-looking session highlight innovations reshaping the delivery of liver care. Presenters explore the use of telehealth and digital tools to expand access to care; the emerging role of artificial intelligence in leveraging electronic medical records; advances in noninvasive testing to improve diagnostic accuracy; and the rapidly evolving field of machine perfusion in solid organ transplantation. The session concludes with interactive, board-style questions to translate innovation into clinical practice.

This basic science symposium explores the fundamentals of and latest advances in endoplasmic reticulum (ER) stress and proteostasis in the pathophysiology of liver injury and chronic liver disease. Potential opportunities for translation of these advances into novel therapeutics are also explored.

Part 1: Fundamentals of the Unfolded Protein Response and Endoplasmic Reticulum Stress 
Part 2: Endoplasmic Reticulum Stress in the Pathophysiology of Liver Injury
Part 3: Endoplasmic Reticulum Stress in the Progression of Chronic Liver Disease
Part 4: Bench to Bedside—Opportunities for Therapeutic Targeting of the Unfolded Protein Response and Endoplasmic Reticulum Stress in Acute and Chronic Liver Disease 
 

The debrief sessions summarize the highest impact papers addressing key topics across the field of hepatology presented during The Liver Meeting. A group of original research reports reflecting major advances in hepatology are succinctly reviewed. Debrief 1 covers pediatric liver disease, liver transplantation, and portal hypertension.

The debrief sessions summarize the highest impact papers addressing key topics across the field of hepatology presented during The Liver Meeting. A group of original research reports reflecting major advances in hepatology are succinctly reviewed. Debrief 2 addresses basic science research, hepatitis, hepatocellular carcinoma, cholestatic liver disease, metabolic dysfunction–associated liver disease, alcohol-associated liver disease, and MetALD.