Early recognition and classification of acute-on-chronic liver failure (ACLF) remains a major challenge, often resulting in delayed care and missed critical intervention windows. As global definitions evolve, clinicians must apply these frameworks in real time—sometimes before formal criteria are met. This expert session utilizes case-based discussions to demonstrate how experienced providers identify ACLF early, operationalize consensus definitions, and make high-impact decisions during the first hours to days of illness. Practical strategies, common diagnostic pitfalls, and judgment-based approaches are highlighted for trainees, early-career clinicians, and practicing providers seeking actionable guidance for real-world ACLF care.

Managing acute-on-chronic liver failure (ACLF) in the intensive care unit often involves navigating some of the most complex and ethically charged decisions in hepatology and critical care. Experts explore the pivotal moments when clinicians must decide whether to escalate aggressive organ support or transition toward palliative approaches.

Presenters share evidence-based strategies for advanced multiorgan support—including renal replacement therapy, vasopressor management, and ventilatory support—while addressing the nuances of transplant candidacy and futility assessment. Faculty also highlight emerging technologies, evolving ethical considerations, and practical tools for guiding conversations with families and multidisciplinary teams. Through real-world case discussions, participants gain insight into balancing survival benefit against resource limitations, integrating patient values, and applying consensus frameworks under time pressure.

Metabolic dysfunction–associated steatotic liver disease (MASLD) is now so prevalent that coexistence with autoimmune liver diseases—including autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC)—has become a frequent real-world scenario. This comorbid overlap creates diagnostic uncertainty and introduces management tradeoffs.

Experts synthesize what is known about the prevalence and clinical impact of MASLD overlap in autoimmune liver diseases, drawing from the most up-to-date literature and emerging registry data. Presenters review signals that MASLD may worsen prognosis and treatment response in cholestatic and autoimmune hepatitis, which are increasingly recognized and under active study. Speakers also focus on practical diagnostic and management approaches: phenotype parsing (metabolic versus immune activity); use and limitations of noninvasive tests and histology; and an integrated treatment strategy that addresses both autoimmune disease control and metabolic drivers of progression. Faculty conclude by addressing how new metabolic dysfunction–associated steatohepatitis (MASH)–directed agents intersect with autoimmune liver disease care—including where therapies such as resmetirom fit conceptually and operationally, and what safety/monitoring considerations are especially relevant when concomitant or uncontrolled autoimmune liver disease is present. Attendees gain a pragmatic framework for evaluating overlap, prioritizing interventions, and anticipating the next wave of evidence in this rapidly evolving space.

Ileal bile acid transporter (IBAT) inhibitors have emerged as a novel and increasingly relevant therapeutic class in the management of cholestatic liver diseases. Initially developed to address cholestatic pruritus through interruption of enterohepatic bile acid circulation, these agents have demonstrated meaningful symptomatic benefit across multiple cholestatic conditions. However, growing clinical experience and evolving mechanistic insights have raised important questions regarding their potential role beyond symptom control.

Presented by the Cholestatic Autoimmune Liver Disease Special Interest Group, experts in this session provide a focused review of IBAT inhibitors, including their mechanism of action, clinical trial data, and current use in cholestatic liver diseases. Presenters highlight the distinction between symptomatic management and the emerging hypothesis that IBAT inhibition may influence disease biology, inflammation, and progression.

Gene therapy trials for liver diseases present unprecedented opportunities for both patients and investigators. While offering the potential for durable disease modification for patients, gene therapies also raise complex questions for investigators regarding informed consent, heightened safety monitoring requirements, equity of access, pediatric enrollment, long-term follow-up obligations, and investigator responsibility for therapies with potentially irreversible effects.

The Clinical Research Committee and Pediatric Special Interest Group jointly sponsor this expert session that provides an informal, small-group forum for in-depth discussion with recognized leaders in pediatric hepatology, genetics, and research ethics. Presenters focus on real-world challenges faced by investigators conducting liver-directed gene therapy trials for conditions such as urea cycle disorders, Wilson disease, and alpha-1 antitrypsin deficiency as well as acquired conditions such as hepatitis B. Discussion topics include: managing uncertainty and expectations; balancing innovation with patient protection; long-term follow-up obligations; and how investigators can responsibly integrate gene therapy into clinical research and practice. Speakers aim to equip attendees with the tools necessary to ensure safe, ethical, and effective implementation of these trials across research sites.

This expert program showcases the latest developments in human models of liver diseases. In alignment with the US National Institutes of Health initiative to expand innovative, human-based science efforts, speakers highlight current nonanimal models such as organoids and precision cut tissue slices. Presenters discuss how to obtain and implement these nonanimal models; approaches to model liver diseases with them; and the appropriate applications. Experts convey their perspectives on the future of human-based liver disease models.

Join topic experts for this intriguing session that explores the emerging therapeutic landscape for treating alcohol use disorder (AUD) and alcohol-associated liver disease (ALD). Speakers focus specifically on fibroblast growth factor 21 (FGF21) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in the context of AUD and ALD. Presenters also explore future translational research questions involving FGF21 and GLP-1 RAs.

Faculty review the practical aspects of implementing integrated alcohol-associated liver disease (ALD) care. Topics include organizing a care team, development of a business plan, and barriers and pitfalls as presented by experts who have successfully started integrated ALD care programs.

Porto-sinusoidal vascular disorder (PSVD) has recently undergone a major conceptual shift with changes in both its name and diagnostic definition, accompanied by the development of a new diagnostic score. Despite these advances, PSVD remains a frequently underdiagnosed and misdiagnosed condition with limited awareness across clinical settings. Disease mechanisms, natural history, and trajectories are still incompletely understood; significant gaps remain in patient identification and cohort harmonization.

Experts review the evolving definition of PSVD; discuss the rationale and application of the new diagnostic criteria and scoring system; and examine current challenges in diagnosis, phenotyping, and disease classification. Through expert insights and case-based discussion, the session highlights unmet needs in understanding PSVD pathophysiology and clinical course, and outlines priorities for improving recognition, diagnosis, and collaborative research efforts.

Primary and secondary prophylaxis for spontaneous bacterial peritonitis (SBP) has been a cornerstone of cirrhosis management for decades, informed by early studies suggesting a survival benefit and reduced infectious complications. As a result, long-term antibiotic prophylaxis has become routine practice for many persons with advanced liver disease. Emerging evidence, however, is challenging this paradigm. Recent randomized controlled trials have failed to demonstrate clear survival benefits in selected populations while analyses of large retrospective cohorts raise concerns regarding limited effectiveness in real-world settings. Further, increasing antibiotic resistance, shifts in bacterial epidemiology, and unintended consequences of prolonged antibiotic exposure have brought renewed scrutiny to SBP prophylaxis strategies.

Experts critically review the evolving evidence base for SBP prophylaxis, examine discrepancies between historical assumptions and contemporary data, and explore how new findings should inform patient selection, risk stratification, and future clinical guidelines.