Acute-on-chronic liver failure (ACLF) is the focus of this joint symposium from AASLD and the Asian Pacific Association for the Study of the Liver (APASL). ACLF is a complex syndrome characterized by acute hepatic decompensation in the setting of chronic liver disease leading to multiorgan failure and high short-term mortality. However, the definition, classification, and management strategies for ACLF vary significantly between APASL and AASLD guidelines. The program begins with an in-depth exploration of ACLF definitions as per APASL and AASLD, highlighting key clinical differences via case-based presentations. Expert discussions follow focusing on management strategies from both AASLD and APASL perspectives. While AASLD emphasizes early liver transplantation and intensive care, APASL advocates for aggressive medical management, including liver regeneration therapies. Understanding these distinct approaches is crucial for optimizing patient care, particularly in resource-limited settings.