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 - Debbie Shawcross, BSc, MBBS, PhD, FRCP, FAASLD

1:20 – 1:35 p.m. Plenary: International Variability in ACLF and Portal Hypertension: Regional Differences and Critical Evidence Gaps - Jasmohan Bajaj, MD, FAASLD

1:35 – 1:50 p.m. Plenary: Registry Quality and Trial Generalizability: Building a Foundation for Robust Evidence - Ruben Hernaez, MD, MPH, PhD

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 - Thomas Reibeger, MD

3 – 3:15 p.m. Risk Stratification Across Disease Stages: Can NITs Enhance Prediction? - Mattias Mandorfer, MD, PhD

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

3:30 – 3:45 p.m. Portal Hypertension and ACLF in the era of MASLD & Cholestatic diseases: Are We Facing Different Biology? - Mazen Noureddin, MD, MHSc, FAASLD

3:45 – 4 p.m. Pathways to Recovery: Exploring Recompensation in ACLF- Anahita Rabiee, MD

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 - Joanna Dionne, MD, MS, PhD

8:25 – 8:40 a.m. Management of Gastrointestinal Hemorrhage in ACLF: An Integrated Multimodal Approach - Nicolas Intagliata, MD

8:40 – 8:55 a.m. Mental Status Changes in ACLF: Untangling Encephalopathy and Critical Illness - Patricia Bloom, MD

8:55 – 9:10 a.m. Nutritional Strategies in ACLF: Preserving Lean Muscle Mass in the ICU - Andres Duarte-Rojo, MD, PhD, FAASLD

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

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 - Sumeet Asrani, MD, MSc

10:15 – 10:30 a.m. Thrombosis and Coagulation in Portal Hypertension: Practical Anticoagulation and Procedure Safety - Patrick Northup, MD, FAASLD

10:30 – 10:45 a.m. Interventional Decision Making in 2027: TIPS, BRTO, and Alternatives—When, Why, and For Whom - Virginia Hernandez-Gea, MD, PhD

10:45 – 11 a.m. Reassessing Therapeutic Albumin: Where Do We Stand? - Elsa Solà, MD, PhD

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

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 - Julia Wendon, MBChB, FRCP

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

1:30 – 1:45 p.m. Renal Replacement Therapy in ACLF: Timing, Modality Selection, and Prognostic Turning Points - Constantine Dean Karvellas, MD, SM, FRCPC, FCCM

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

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

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? - Brett Fortune, MD, MS

8:20 – 8:35 a.m. ACLF Grades and Transplant Timing: How to Operationalize Risk and Opportunity - Christina Lindenmeyer, MD

8:35 – 8:50 a.m. Bridging Strategies to Transplant in Severe Portal Hypertension - Juan Abraldes, MD

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

9:05 – 9:20 a.m. Immunologic and Infectious Vulnerability Pre-Transplant in ACLF: What Makes This Population Unique? - K. Rajender Reddy, MD, FAASLD

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