The global ACLF consensus : The ‘Istanbul document’

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dc.authorid0000-0001-6540-2623
dc.authorid0000-0002-9163-8928
dc.authorid0000-0002-9997-6569
dc.authorid0000-0002-2221-9148
dc.authorid0000-0002-8909-2102
dc.authorid0000-0002-0544-5610
dc.contributor.authorKulkarni, Anand V.
dc.contributor.authorChoudhury, Ashok
dc.contributor.authorArora, Vinod
dc.contributor.authorDökmeci, Abdul Kadir
dc.contributor.authorKoshy, Abraham
dc.contributor.authorGürakar, Ahmet
dc.contributor.authorDuseja, Ajay
dc.contributor.authorRoy, Akash
dc.contributor.authorÖrmeci, Necati
dc.contributor.authorSarin, Shiv Kumar
dc.date.accessioned2026-11-04T17:41:54Z
dc.date.available2026-11-04T17:41:54Z
dc.date.issued2026
dc.departmentFakülteler, Tıp Fakültesi, Dahili Tıp Bilimleri Bölümü, İç Hastalıkları Ana Bilim Dalı
dc.description.abstractThe 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.
dc.identifier.citationKulkarni, A. V., Choudhury, A., Arora, V., Dökmeci, A. K., Koshy, A., Gürakar, A., Duseja, A., Roy, A., Örmeci, N., & Sarin, S. K. (2026). The global ACLF consensus : The ‘Istanbul document’. Hepatology International, 20(5), pp. 1281-1294. https://doi.org/10.1007/s12072-026-11136-x
dc.identifier.doi10.1007/s12072-026-11136-x
dc.identifier.endpage1294
dc.identifier.issn1936-0541
dc.identifier.issn1936-0533
dc.identifier.issue5
dc.identifier.pmidPMID: 42782569
dc.identifier.scopus2-s2.0-105052642850
dc.identifier.scopusqualityQ1
dc.identifier.startpage1281
dc.identifier.urihttps://doi.org/10.1007/s12072-026-11136-x
dc.identifier.urihttps://hdl.handle.net/20.500.13055/1691
dc.identifier.volume20
dc.identifier.wosWOS:001904788300001
dc.identifier.wosqualityQ1
dc.indekslendigikaynakWeb of Science
dc.indekslendigikaynakScopus
dc.indekslendigikaynakPubMed
dc.indekslendigikaynak.otherSCI-E - Science Citation Index Expanded
dc.institutionauthorÖrmeci, Necati
dc.institutionauthorid0000-0002-8909-2102
dc.language.isoen
dc.publisherSpringer Nature Link
dc.relation.ispartofHepatology International
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanı
dc.rightsinfo:eu-repo/semantics/closedAccess
dc.subjectCirrhosis
dc.subjectChronic Liver Disease
dc.subjectLiver Failure
dc.subjectType-A ACLF
dc.subjectType-B ACLF
dc.subjectDecompensation
dc.subjectOrgan Failure
dc.subjectHarmonization
dc.subjectOrgan Dysfunction
dc.subjectJaundice
dc.subjectAscites
dc.titleThe global ACLF consensus : The ‘Istanbul document’
dc.typeArticle
dspace.entity.typePublication

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