Anand V Kulkarni, Ashok Choudhury, Vinod Arora, Abdul Kadir Dokmeci, Abraham Koshy, Ahmet Gurakar, Ajay Duseja, Akash Roy, Akash Shukla, Aleksander Krag, Alfred Wei Chieh Kow, Ananta Shrestha, Apichat Kaewdech, Ashish Goel, Ashish Kumar, Ashwani K Singal, Aung Hlaing Bwa, Chanunta Hongthanakorn, Cosmas Rinaldi Adithya Lesmana, Daniel Huang, Darrell Crawford, Debbie Shawcross, Deniz Balchi, Dhiraj Agrawal, Diana A Payawal, Do Seon Song, Dong Joon Kim, Fernando Bessone, George K Lau, Giacomo Germani, Girish Kumar Pati, Grace L Su, Guan-Huei Lee, Gupse Adali, Gyongyi Szabo, Hasmik Ghazinian, Jacob George, James Fung, Jasmohan Bajaj, P Javed, Jidong Jia, Jimmy Che-To Lai, Jin Jun Chen, Jonel Trebicka, Jun Li, Kavish Patidar, Kemal Fariz Kalista, Ken Liu, Kessarin Thanapirom, Lai Wei, M Golam Azam, Madhumita Premkumar, Madunil Niriella, Manasa Alla, Mangesh Pagadala, Manoj Kumar, Manuel Mendizabal, Mario Guimaraes Pessoa, Mark Dhinesh Muthiah, Masao Omata, Mazen Noureddin, Md Fazal Karim, Mithun Sharma, Mohamed Alboraie, Mohamed Elbasiony, Murat Harputluoglu, Narendra Singh Choudhary, Nazia Selzner, Necati Ormeci, Nelia Hernandez, Nipun Verma, Paolo Angeli, Phunchai Charatcharoenwitthaya, Prabir Maji, Pravin Rathi, R K Dhiman, Rahul Kumar, Rakhi Maiwall, Ramazan Idilman, Richard Moreau, Rino A Gani, Rosmawati Mohamed, S S Hamid, Sanjeev Sachdeva, Senamjit Kaur, Shahinul Alam, Soe Thiha Maung, Soek-Siam Tan, T R Sowmya, K C Sudhamshu, Sumana Ramachandra, Sunil Kumar Dadhich, Sunil Taneja, Suprabhat Giri, Surender Singh, Tao Chen, Tarana Gupta, Tushar Madke, V M Dayal, Venishetty Shantan, Viniyendra Pamecha, Wong Yu Jun, Xiaolong Qi, Yoon Jun Kim, Zaigham Abbas, Zobair M Younossi, Shiv Kumar Sarin, APASL-ACLF Research Consortium (AARC) for APASL-ACLF working party
The Kyoto Consensus introduced a key conceptual shift in characterizing acute-on-chronic liver failure (ACLF) patients into Type-A and Type-B phenotypes. A day-long meeting was convened at Istanbul during APASL 2026 to assess the real-world applicability of Type-A and Type-B ACLF across continents. The objective was that physicians could recognize ACLF as a unified disease entity, and quality research and new therapeutic options with defined end-points could be undertaken. Data from APASL ACLF Research Consortium (AARC), EASL-CLIF and NACSELD were assessed and discussed in detail. While the applicability of Type-A and Type-B varied across cohorts, the definition required to be appended. The experts unanimously agreed that 'liver failure' as identified by serum bilirubin of ≥ 5 mg/dl and INR ≥ 1.5 should be the 'core' for both Type-A and Type-B ACLF. Type-A ACLF is considered when "a patient with compensated advanced chronic liver disease or compensated cirrhosis presents with index decompensation as liver failure followed by development of ascites and/or hepatic encephalopathy within 4 weeks." Type-B ACLF is considered when "a patient with prior or concurrent decompensated cirrhosis presents with acute decompensation as liver failure accompanied by one or more extrahepatic organ failures." New definitions of organ dysfunction and failure, as well as endpoints for clinical trials, were also deliberated and finalized. The "Istanbul Report", presents a milestone evidence based consensus document carrying harmonization of various aspects of ACLF, incorporating current evidence, critically analyzed unanimous recommendations, and key areas for future studies.