2027 Spring Emerging Topic Conference: ACLF & Portal Hypertension — From Mechanism to Mastery

Session 1: Acute on Chronic Liver Failure Redefined: Phenotypes, Taxonomies, and the Imperative for Global Harmonization 

1 – 1:20 p.m. Keynote Lecture: Toward a Unified Nomenclature: Reconciling Clinical Phenotypes and International Consensus 

1:20 – 1:35 p.m. Plenary: International Variability in ACLF and Portal Hypertension: Regional Differences and Critical Evidence Gaps 

1:35 – 1:50 p.m. Plenary: Registry Quality and Trial Generalizability: Building a Foundation for Robust Evidence 

1:50 – 2:30 p.m. Moderated Panel Discussion 

2:30 – 2:45 p.m. Break 

Session 2: The Portal Hypertension–ACLF Interface: Biological Determinants and Risk Trajectories 

2:45 – 3 p.m. Hemodynamic and Molecular Pathways Linking Portal Hypertension to Disease Acceleration 

3 – 3:15 p.m. Risk Stratification Across Disease Stages: Can NITs Enhance Prediction?  

3:15 – 3:30 p.m. Alcohol-associated Liver Disease as a Driver of ACLF: Distinct Physiology, Triggers, and Trajectories  

3:30 – 3:45 p.m. Portal Hypertension and ACLF in the era of MASLD & Cholestatic diseases: Are We Facing Different Biology?  

3:45 – 4 p.m. Pathways to Recovery: Exploring Recompensation in ACLF 

4 – 4:15 p.m. Panel Discussion 

4:15 – 4:30 p.m. Break 

Session 3: Grand Rounds Live: Fellows’ Stump the Hepatologist  

4:30 – 6 p.m.  Grand Rounds Live: Fellows' Stump the Hepatologist  

• Brings trainees and faculty together for a lively, case-based discussion centered on some of the most challenging clinical scenarios in portal hypertension, ACLF, and liver transplantation. Fellows will present and moderate complex cases, inviting expert panelists to work through diagnostic and management decisions in real time while audience members participate through live polling. 

6 – 7:30 p.m. Welcome Reception with posters (Food and drink provided)

Session 4: Advanced Clinical Management in ACLF: Strategies for High Acuity Care  

8 – 8:10 a.m. Welcome Intro 

8:10 – 8:25 a.m. Initial Stabilization in ACLF: Defining Priorities in High‑Acuity Care  

8:25 – 8:40 a.m. Management of Gastrointestinal Hemorrhage in ACLF: An Integrated Multimodal Approach 

8:40 – 8:55 a.m. Mental Status Changes in ACLF: Untangling Encephalopathy and Critical Illness 

8:55 – 9:10 a.m. Nutritional Strategies in ACLF: Preserving Lean Muscle Mass in the ICU 

9:10 – 9:25 a.m. From Stabilization to Mobilization: An Integrated Approach to Frailty and Post-ICU Recovery 

9:45 – 10 a.m. Break 

Session 5: Contemporary Management of Portal Hypertension: Hemostasis, Decompensation, and Interventional Pathways 

 10 – 10:15 a.m. Ascites, Hydrothorax, and SBP: Evidence Based Algorithms for Refractory Fluid Syndromes 

10:15 – 10:30 a.m. Thrombosis and Coagulation in Portal Hypertension: Practical Anticoagulation and Procedure Safety 

10:30 – 10:45 a.m. Interventional Decision Making in 2027: TIPS, BRTO, and Alternatives—When, Why, and For Whom 

10:45 – 11 a.m. Reassessing Therapeutic Albumin: Where Do We Stand? 

11 - 11:15 a.m. Non-Selective Beta Blockers in Portal Hypertension: Expanding Indications, Limits, and Precision Use 

11:15 – 11:30 a.m. Panel Discussion 

11:30 – 1 p.m. Lunch Break 

Session 6: Critical Care of the Patient with ACLF: Organ Support Strategies That Influence Outcome 

1 - 1:15 p.m. Vasopressor Use and Hemodynamic Targets in ACLF: A Precision Approach 

1:15 – 1:30 p.m. Ventilation, ARDS, Aspiration, and HE: Respiratory Support in the Critically Ill ACLF Patient 

1:30 – 1:45 p.m. Renal Replacement Therapy in ACLF: Timing, Modality Selection, and Prognostic Turning Points 

1:45 – 2 p.m. Sepsis in ACLF: Rethinking Impact, Management, and Biomarker-Driven Decisions 

2 - 2:15 p.m. Bridging the Crisis: Extracorporeal Liver Support for ACLF in the ICU 

2:15 – 2:30 p.m. Panel Discussion 

2:35 – 2:50 p.m.  Break 

Session 7: Trainee Debate Forum: Controversies in ACLF and Portal Hypertension 

2:50 – 3 p.m. Debate Intro and rules of engagement 

3 – 3:45 p.m. Debate 1: Early liver transplant in ACLF 

3:45 – 4:30 p.m. Debate 2: Rescue TIPS in ACLF: Friend or Foe?  

4:30 – 4:35 p.m. Session Closing 

4:35 p.m. Day 2 Concludes 

Session 8: Liver Transplantation in Portal Hypertension and ACLF - Candidacy, Timing, and Post‑Transplant Complexities 

8 – 8:05 a.m. Welcome Intro 

8:05 – 8:20 a.m. Transplant Candidacy in the Era of Portal Hypertensive Crisis: When Is It Too Early or Too Late? 

8:20 – 8:35 a.m. ACLF Grades and Transplant Timing: How to Operationalize Risk and Opportunity 

8:35 – 8:50 a.m. Bridging Strategies to Transplant in Severe Portal Hypertension 

8:50 – 9:05 a.m. Outcomes After Transplant for ACLF and High‑Pressure Physiology: What 2027 Data Tell Us 

9:05 – 9:20 a.m. Immunologic and Infectious Vulnerability After Transplant in ACLF: What Makes This Population Unique? 

9:20 – 9:40 a.m. Interactive QA 

9:40 – 10 a.m. Break 

Session 9:   Transforming ACLF Trials: Designing for Diversity, Defining Better Endpoints, and Targeting Next Generation Therapies Roundtable Discussions 

10 – 11 a.m.  ACLF Endpoints That Matter: A Roundtable with FDA, Industry, Clinicians, and Patients   

11 – 11:15 a.m. Break 

Session 10: Interactive Forum: Quality of Life and the Path Back to Everyday Living 

11:30 – 12 p.m. Dialogue Between Patients and Care 

12:30 p.m. Program Concludes