Hepatology

Adult Critical Care Hepatology Services:

Hepatology department offers diagnosis and treatment of hepatobiliary diseases including alcohol associated liver disease, metabolic dysfunction associated fatty liver disease, viral hepatitis, auto-immune hepatitis, drug induced liver disease, storage disorders, gall stones and bile duct stones, pancreatic diseases, and liver cancer, pancreato-biliary cancers and rare and orphan liver diseases.

• 1. Liver Intensive Care

  The institute has established one of the finest liver intensive and critical care services with specialized rapid response teams. The LCICU teams include dedicated specialists from the Hepatology team (Prof. Rakhi Maiwall, Dr. Harsh Vardhan Tevethia and Prof. S.K.Sarin) and the Critical Care team (Dr. Deepak Tempe, Dr Prasant Aggarwal, Dr. Sonam and Dr. Priyanka) round the clock. We provide care guided by a protocol-based treatment and rapid response by a multidisciplinary team ably supported by the nephrology, cardiology, and pulmonology teams.

• 2. Acute Gastrointestinal (GI) Bleeds:

  Patients with acute GI bleed are seen immediately in the emergency room and appropriate treatment (including endotherapy, interventional radiology procedures etc.) is given immediately.

  There is a separate GI bleed ICU of 5 beds, which is looked after by Dr. Ankur Jindal, Additional Professor, Hepatology, which maintains protocol based treatment for acute UGI bleeds in portal hypertensive patients.

• 3. Hepatic Coma : Hepatic encephalopathy is the occurrence of confusion, altered level of consciousness, and coma as a result of liver failure. New approaches including use of ammonia and bilirubin filters, continuous renal replacement therapy (CRRT) and plasma exchange (PLEX) have helped improve outcomes.

• 4. Acute Liver Failure (ALF): ILBS has been involved in the treatment of ALF patients with a rapid response team working round the clock and with the availability of urgent liver transplantation the outlook of this disease has improved substantially. Specialized monitoring with Optic Nerve Sheath Diameter (ONSD) measurement and transcranial Doppler improved our diagnostic capabilities. Apart from this, we do therapeutic PLEX which removes a wide array of inflammatory toxins and cytokines, endotoxin, DAMPS and facilitates recovery of the failing liver. We have done this therapy in more than 850 patients in our ICU in 2025.

• 5. Acute-on-Chronic Liver failure (ACLF): Liver failure can also develop on pre-existing liver disease, called as acute-on-chronic liver failure (ACLF). This entity was first defined in India and ILBS has henceforth carried intensive research in this disease and developed effective treatments for this deadly condition. ILBS serves as the nodal center for the Asian Pacific Association for the Study of the Liver ACLF Research Consortium (AARC) coordinated by Dr. Ashok Choudhury and Dr Vinod Arora.

  At ILBS, there has been an ever-increasing referral of patients for management of these emergencies as shown in the figure below.

• 6. Artificial Liver Support : Artificial liver support systems have been used to remove the putative toxins and inflammatory cytokines. These therapies can be used as a bridge for spontaneous recovery or transplantation in patients with ALF and acute on chronic liver failure (ACLF) These therapies have also been effectively offered to patients with drug induced liver injury, hemophagocytic lympho histiocytic syndrome, intractable pruritus secondary to intrahepatic cholestasis and autoimmune hepatitis who have failed steroid therapy.

  We at ILBS are also trying to develop our "bioartificial liver" with extracorporeal bioreactors containing hepatocytes which can provide additional synthetic and biotransformatory liver functions.

• 7. Acute Kidney Injury (AKI): AKI is a frequent and ominous complication in critically ill liver disease patients. At ILBS, we have the facility to perform biomarkers (like cystatin C and urine neutrophil gelatinase associated lipocalin) for diagnosis and prognosis of AKI. Our liver intensive care is equipped with 24x7 dialysis services and offers with the help of able nephrology team, intermittent hemodialysis, slow low exchange dialysis (SLED) as well as CRRT. We have done more than 1300 SLED procedures and more than 2050 CRRTs in patients with liver failure with AKI in 2025. We are the first center in the world globally to demonstrate in a randomized controlled trial the benefits of early initiation of dialysis in septic shock in incidence of renal recovery. We are also using several blood purification devices therapies. We have the largest experience in the country and have successfully performed blood purification therapies in around 220 patients with refractory septic shock and/or severe acute respiratory distress syndrome with favourable results.

• 8. Assessment and Management of Coagulation Failure : Critically ill patients with liver disease frequently have coagulation abnormalities. Unlike convention al coagulation tests, newer viscoelastic tests (like Rotem and TEG) dissects the dynamics of clot formation, ultimate clot strength, and the stability of the clot. In 2025, we performed more than 5,000 of these tests for managing the coagulation failure in these critically ill patients.

• 9. End of Life Care : In patients with cirrhosis and liver cancer, end of life is an important aspect of care. As a part of this, care is focused on palliating a terminally ill patient's pain and other symptoms and attending to their and their family's emotional and spiritual needs.

OTHER PATIENT SERVICES AT HEPATOLOGY DEPARTMENT:

• 1. Hepatitis B and C: Hepatitis Band C are common causes of chronic liver disease in India and nearly 45 and 12 million people are estimated to be infected with these viruses in India respectively. They are also common causes of cirrhosis and liver cancer in India. The area is led by Prof. Manoj Kumar and Dr Ankur Jindal.

• 2. Hepatocellular Carcinoma (HCC): HCC has been increasing in India and worldwide, with metabolically associated fatty liver disease (MAFL), alcohol use, hepatitis B and C being common causes. Options for HCC include resection, Liver Transplantation, loco-regional therapies (including trans-arterial chemoembolization, radio-frequency ablation, microwave ablation), stereotactic radiotherapy, and systemidimmunotherapies as per protocol ILBS sees one of the largest referrals for hepatitis B, C and Liver cancer as shown in figure. In 2025, ILBS has added transarterial radio-embolization (TARE) as a new therapeutic modality for HCC patients.

  A. MWA probe into the tumour site injected	B. Superselective DEB-TACE catheter with lipioidal seen inside the tumour

• 3. Alcohol associated liver disease (ALD):At ILBS, liver disease due to alcoholic use is the most common diagnosis requiring admission. ALD constitutes more than 40% of our in-patients and 2/3rds of our patients with acute-on-chronic liver failure. [Figure] We have protocol based treatments available for alcoholic hepatitis patients led by Dr Shasthry SM. We are trying to standardize protocols, which could in future become the standard of care in the management of severe alcoholic hepatitis patients.

• 4. Liver Stiffness and Fat Measurement: Early diagnosis and intervention can lead to a substantial reduction in morbidity and mortality from all conditions that lead to cirrhosis. Liver stiffness is important for evaluating the stage of liver fibrosis. Controlled attenuation parameter (CAP) gives measurement of liver fat, recently splenic stiffness has been used for evaluation of portal hypertension. Splenic stiffness can also be used for prognosticating cirrhosis patients.

  ILBS has six such machines, which provide rapid and regular services to increasing number of patients. In addition to 27446 liver stiffness measurements we have also done, 8326 splenic stiffness measurements in 2025.

• 5. Endoscopy Services: The department of hepatology provides most comprehensive endoscopic services- both diagnostic and therapeutic, with Dr Vikram Bhatia as overall in-charge. Our spacious endoscopy unit has seven fully equipped rooms- two for gastroscopy, one for colonoscopy, one each for endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS), cholangioscopy, lntraductal ultrasound, one balloon enteroscopy room, and one room for extra- corporeal shock wave lithotripsy (ESWL).

  Experienced endoscopists, nurses and anesthesiologists receive all patients in a spacious day care reception area, where they are assessed pre-procedure. All elective endoscopic procedures at ILBS are carried out with tailored sedation provided by consultant anesthesiologists. After the procedures, patients are monitored in a segregated post-procedure observation area with full monitoring facilities and privacy. The services are efficiently supervised by a Resident Medical Officer, Dr. lshant Bhardwaj.

  'Our interventional radiology services work in tandem, and provide salvage angioembolization, TIPS, BRTO, PARTO or CARTO services for difficult to control or inaccessible bleeding sources. ILBS has one of the largest experiences in emergency TIPS stent placement.

  We have dedicated on-site cytopathology services, with EUS sampling adequacy rates exceeding 97%. We are routinely doing intra-gastric balloon (1GB) placements for management of patients with morbid obesity with perceivable results. Approx 200 1GB placements have been done so far till 2025

  We strive to make endoscopy a pleasant experience for all patients, with attention to small details including lockers for personal belongings, clean clothes and towels, clean toilet facilities, and post-procedure discussion of the findings. Our smiling and pleasant staff is trained to put patient apprehensions at ease.

  Trends of numbers for different procedures performed

• 6. Hepatic Hemodynamic Laboratory: The hepatic hemodynamic laboratory is the backbone of Hepatology services. Under the supervision of Dr. Ankur Jindal, Dr V Rajan and Dr Satender Pal Singh it provides detailed insight into the liver pressure which determines the outcome of patients with liver disease. Measurement of the hepatic venous pressure gradient (HVPG) is currently the best available method to evaluate the presence and severity of portal hypertension. Other unique features of this laboratory are accurate measurement of pulmonary pressures and right heart studies, which are helpful in accurate diagnosis of porto-pulmonary hypertension and measurement of cardiac output. Simultaneous liver biopsy sampling through the transjugular route is done in patients with ascites and liver disease enabling accurate diagnosis and severity assessment of liver disease.

  'Because of its relatively invasive nature and domain skills, this facility is available in very few centers in the world. We at ILBS regularly perform this procedure taking due precautions that all the steps are performed with precision and patient safety. taking due precautions that all the steps are performed with precision and patient safety.

• 7. Liver Regeneration and Stem Cell Therapy: Only about 2-5% of patients, with advanced cirrhosis are able to get liver transplant. Lack of a donor, very advanced stage, financial and social issues are the major limitations. There is therefore an urgent need to provide alternative methods of maintaining and improving liver functions. In this regard, emerging science of regenerative medicine is considered an effective alternative therapeutic approach that can effectively manage the necro- inflammatory death of hepatocytes, potentiate immunomodulation and thus promote native liver regeneration and repair.

  The field of liver regeneration is led by Dr. S. K. Sarin, Dr. Rakhi, Dr. Anupam and Dr. Chhagan Bihari at ILBS. ILBS has done many seminal scientific works in the field of regenerative medicine. Growth factor administration was shown to be a simple and novel method of mobilizing BMSCs.

  ILBS is also researching on cell based therapies (including mesenchymal stem cell, macrophage therapy), transplant of bone marrow cells and/ or exosome infusion from allogeneic healthy bone marrow for liver failure. ovel interventional approaches, including Recently, in collaboration with IIT Kanpur, we have worked on a bio-artificial Liver (BAL) device and use of decellularized liver for this purpose. We aim for a future in which no patient with liver disease dies due to failure to get liver transplant.

• 8. Transplant Hepatology: Our transplant hepatology team is led by Prof Shiv K Sarin and assisted by Dr Ashok Choudhury and Dr Satender Pal Singh. ILBS is one of the few public sector hospitals in Govt setting to have a successful transplant programme with nearly 150 cases per year of transplant with a total of more than 1312 cases done till date and the number is increasing. In 2025, 162 liver transplants have been done. This is possible due to Transplant Surgery team by Prof Viniyendra Pamecha. Cadaver transplant, as well as maintenance of transplant waiting list in strict accordance of the NOTTO Guidelines is a great achievement where patients are routinely followed by Transplant Hepatology team and record maintained by Transplant Coordination department led by Ms. Vandana, a passionate and dedicated person. The immediate post-transplant care is offered by surgical, medical and anaesthesia resident doctors, nursing staff and dedicated team round the clock for any emergencies and a dedicated post-transplant ward. Post-transplant complications are uncommon; and if they occur, they are managed well. Translational research (non-invasive methods for early detection of graft rejection, cell based therapy for steroid resistant rejection and immunoscan, etc.) is being carried out and various strategies to increase organ donation awareness, organ retrieval and promotion of cadaver transplant are our priority areas.

• 9. Protocol Based Treatment: For most of the liver disease patients the department has been able to standardize the treatment protocols.

• 10. Patient Support Services: For patients with liver diseases highly skilled and trained nurses are available to monitor the patient treatment and outcomes.

• 11. Department of Clinical Nutrition: The department of Clinical Nutrition (CN) is a tangible dimension to the discipline of "nutrition" in the realm of medicine. The department has come a long way over the past thirteen years and has achieved excellence holistically based on the three fundamental pillars of ILBS i.e. patient care, academics and research.

  Patient care: The department of Clinical Nutrition is committed to patient care of both inpatients and outpatients especially the patients with various liver diseases, critically ill and the post liver transplant patients. Keeping nutritional management as a priority, CN works in close liaison with the treating team of physicians, surgeons and critical care intensivists. The department also runs Liver Nutrition OPDs contributing to facilities of assessment of the nutritional status using a bioelectrical impedance analysis, anthropometry, indirect calorimetry and other collaborative radiolaogical assessment techniques.

  It offers nutritional consultations to more than 500 liver disease patients with various diseases including those with liver cirrhosis, NAFLD, post ICU discharge transplant waitlisted, post LT patients and organ transplant donors who are in regular follow-up in the OPD, apart from any special referrals from the departments of Pulmonology, Surgery, Psychiatry, Cardiology or Nephrology.

  Teaching: The department independently offers degrees of PhD and post graduate certificate course (PGCC) in Clinical Nutrition apart from other academic collaborations with various departments for the partial fulfilment of the degree of DM, MCh, DNB and MSc. Nursing. The department of Clinical Nutrition is also actively involved in the teaching activities scheduled for the residents, PhD fellows, nursing students, interns and faculty.

  Research: The department of CN does clinical research in close collaboration with the department of Hepatology, HPB Surgery, Molecular and Cellular Medicine and all the other departments at ILBS. Taking leadership in independent extramural projects funded by ICMR, DBT, and ICAR apart from other collaborative extramural grants from CCRAS, AYUSH and Griffols Pharmaceutical USA; clinical nutrition excels in research in this discipline of medicine.

  Courses Offered: Ph.D., PGCC, and Internship in Clinical Nutrition

  Over the last thirteen years the most beautiful part of the department has been its students. Three bright PhD students have gracefully submitted their PhD research and one is presently pursuing PhD in the department, thus taking the count to four PhD fellows in the department. Apart from this four students have been awarded the degree of PGCC in Clinical Nutrition, while three have completed and two are enrolled in the Internship program in Clinical Nutrition.

Services Rendered

New services & facilities

• Fecal (Stool) Microbiota Transplantation (FMT) Unit The human microbiota consists of trillions of microorganisms found in the human body, with the majority of organisms colonizing the gut from mouth to colon. Gut microbiota dysbiosis (imbalances in the composition and function of these intestinal microbes) have pivotal role in the development and progression of many of the liver diseases and their complications, most importantly - non-alcoholic steatohepatitis, alcoholic liver disease, alcoholic hepatitis, hepatic encephalopathy, sepsis in liver diseases etc. Fecal (stool) microbiota transplantation (FMT) involves acquiring healthy microbes from a related donor and then instilling these into the GI tract of the diseased individual. At ILBS, FMT is being used as a novel method in the treatment of severe alcoholic hepatitis, alcohol use disorders, and severe reactivation of hepatitis B virus. The work in the FMT lab is co-ordinated by Dr Shasthry SM, with the help of Dr. Pratibha Kale, DrVikas Khillan and Dr SK Sarin.

• Albumin Ward: Due to increased demand of day care services like large volume paracentesis, pleural fluid paracentesis (in hepatic hydrothorax) albumin infusions etc. we have opened a new albumin day care in Phase-2, first floor since June 2017. The ward offers facilities to the needy patients in three shifts, with prior appointment. Dedicated telephone extension has been allocated to take appointments to avail the day care facilities- [Albumin Day Care Phone No. 011-46300000-Extn: 22152]. The ward is catering over 700-800 patients a month since its inception. 3 shifts are being run where about 15-20 patients per shift undergo paracentesis and receive albumin infusion. In the year 2025, this day care has served 7550 patients. The service is supervised by Dr. Varsha Shasthry.

  Endobariatric services: Swallow balloon, and Endoscopic Sleeve Gastroplasty(ESG)
  ILBS has started advanced endo bariatrics procedures including endoscopic sleeve gastroplasty, swallow balloon alongwith intra gastric balloon placement which were being done previously. The team is led by Dr(Prof)Shiv Kumar Sarin, Dr Harsh Vardhan Tevethia. An dedicated Dietary team led Dr Uma oversees all patients undergoing these procedures. Till date ILBS remains one of the few institutions in the government set up in India to have an dedicated advanced endo bariatric programmes.

  EUS guided liver biopsy
  In continuation with percutaneous liver biopsy, transjugular liver biopsy being done at the institute ILBS offers services including EUS guided Liver biopsy. Till date over 450 cases have done using this techniques with excellent results. Multiple studies are being done at national and international arena in this topic.

Training and CME

Regular training and education programs are conducted for BLS and ACLS certification. Resident doctors, casualty medical officers, nurses and technicians have regular access to high quality clinical CM Es at the institute.

Medical Educational Activities

• Hepatitis Day: The World Hepatitis Day (July 28th, 2025) and 28th Delhi Hepatitis Day (4 Dec 2025) aimed to raise awareness about the global burden of viral hepatitis and encourage action towards its elimination.
• Decisions Reasoning Innovations Learning in Liver Diseases (DRILLS- 2025) an interactive case based annual workshop was organized by ILBS on 7-8 June 2025 with approx. 1250 delegates attending the event. The unique format of DRILLS included presentation of multiple real life clinical cases; the diagnostic dilemmas faced by the treating unit; the challenges in making treatment choices, and discussion on key diagnostic and management issues with active participation from the delegates, moderators and experts alike.
• 6th Annual National Conference on Critical Care & Infections in Liver Diseases (CCILBS) was organized from 27-28 Apr 2025 (2 Days) and about 800 participants attended this congress.
• Hot Topics atAASLD 2025 conference was organized on 15th & 16th Nov 2025.

Department of Hepatology Clinical Training Programs:

• DM Hepatology and PhD Hepatology Courses : Department of Hepatology runs DM in Hepatology and PhD in Hepatology programs. In 2025, eight students were awarded DM hepatology degree: Dr. Omkar S Rudra, Dr. Phool Chand, Dr. Ravi Nishad, Dr. lbrar Ahmed Khan, Dr. Ayush Jain, Dr. SudhirVerma, Dr. Saurav Paul, Dr. Jaifrin Daniel.

• Asia Pacific Association For Study of Liver (APASL) School of Hepatology: APASL School of Hepatology at ILBS, New Delhi, India offers a continuous teaching and training covering diverse aspects in the field of Hepatology. By inviting young fellows or faculty enrolled in hepatology-oriented departments throughout Asia, who want to be exposed to the newest trends in hepatology, the APASL School of Hepatology would achieve the unmet needs of the region.

  Till now ILBS has trained 25 trainees in Hepatology through the APASL School of Hepatology.

  (APASL) School of Hepatology has also started virtual e-Learning seminar series (three series completed till now) for students and fellows.

• Asia Pacific Association Study of Liver (APASL) Liver Cancer Preceptorship Program (ALCAP) The Asia Pacific Association for the Study of the Liver (APASL) Liver Cancer Preceptorship Program (ALCAP) is an educational initiative designed to equip healthcare professionals with comprehensive knowledge and skills in the diagnosis and management of liver cancer. It focuses on the specific needs and challenges faced in the Asian Pacific region, where liver cancer is a major public health burden. Currently monthly online session are being organized under this program. ALCAP program is a successful initiative under supervision of Prof Shiv K Sarin and APASL Core committee and being co-ordinated by Dr Ashok Choudhury.
• World Gastroenterology Organization (WGO) New Delhi Training Center : The New Delhi Training Center at ILBS was inaugurated in New Delhi, India on April 26, 2015 as a WGO Training Center. Till now 4 candidates from different countries have been trained under this training program.
• Other trainees at ILBS : Many trainees and students visited ILBS for observership and hands on training in Department of Hepatology in 2025.

Faculty visited department/Delivered lecture during 2025

Department's Achievements in 2025

Faculty achievements in Academics

EASL Congress 2025 [7-10 May 2025 Amsterdam, the Netherlands]
The following abstracts were accepted by the organising committee of reputed scientific congresses submitted by the respective investigators

Dr. Rakhi Maiwall

• 1. Efficacy of 5% albumin versus plasmalyte in combination with 20% albumin for fluid resuscitation in cirrhosis with sepsis induced hypotension. A randomized controlled trial (ALPS Plus).
• 2. Vasopressin is safe and effective as a second vasopressor in patients with cirrhosis and septic shock: results of the VITEL-C trial. NCT05315557
• 3. Saroglitazar vs. vitamin E in metabolic-dysfunction associated fatty liver disease related compensated chronic liver disease- a cohort study

Dr. Ashok Kumar Choudhury

• 1. A simple lab based machine learning model (FAET) predicts advanced Liver Fibrosis more accurately in MASLD patients
• 2. APASL ACLF research consortium (AARC) liver failure score and first week (transplant window) defines the limits of medical management and time frame for liver transplant in acute on chronic liver failure patients

Dr. Harsh Vardhan Tevethia

• 1. Best Paper- Role of EUS guided liver biopsies in the presence of contraindication to conventional liver biopsies during EUS Summit 2025 Seoul Korea

AASLD The Liver Meeting 2025 [7-11 Nov 2025], Washington, DC, USA

Dr. Rakhi Maiwall

• 1. Differential effects of Vasopressin and terlipressin as Adjunct vasopressors on Hemodynamic parameters in Patients with cirrhosis and septic Shock: final results: from the VITEL-C randomized controlled Trial [nct05315557]
• 2. Incidence, risk factors, and outcomes of major adverse kidney events in patients with decompensated cirrhosis.
• 3. New submission the albumin-bilirubin (ALBI) score predicts kidney failure and mortality in patients with alcohol related acute on chronic liver failure- an analysis from the aarc

Dr. Ashok Kumar Choudhury

• 1. A simple machine learning model considering serum bilirubin, pt-inr and age can accurately predicts the risk of early renal failure in patient of acute on chronic liver failure(ACLF)
• 2. Clinico-radiomic features can stratify clinically significant portal hypertension (CSPH) in patients of cirrhosis noninvasively.
• 3. Portal vein thrombosis (PVT) increases short-term mortality among hospitalized decompensated cirrhosis patients in a global cohort

Artificial Intelligence/Machine learning lab at ILBS

With emergence of artificial intelligence (A.I.) it is imperative that Medical students and clinicians need understanding of Al to be effective in guiding the use of Al applications safely and properly. ILBS has initiated a first of kind in health care - LIVAR lab(Liver innovations virtual artificial reality) lab dedicated for artificial intelligence. The lab is a part of the HepaHub which includes the library where students/faculty interact, learn and foster new ideas .The lab has collaborated with IIT Delhi as well as IIT Bombay on various projects related to A.I. ILBS also proudly announces the establishment as well as collaboration of the A.I-COE initiative (Ministry of education, Government of India) at ILBS. Various teaching initiatives were held at ILBS in the field of A.I including A.I summit in December which was attended by many participants. ILBS also has initiated an online Artificial Intelligence/Machine learning course that will serve to introduce Al concepts for medical professionals, such as interpreting Al models and validation processes. The course will conducted under department of A. I/Augmented intelligence. The course will be an online course with maximum 20 people to be enrolled on first cum basis. There will be an evaluation at the end of the course. Faculties from IIT Delhi as well as ILBS will be a part of it. The duration of the course will be 3-4 weeks (approximate 14 hours) with classes twice weekly. Certificates of completion (ILBS University) will be granted as per scoring at the end of the course.

Department is actively involved in clinical as well as basic research in varied areas such as Portal hypertension and its complications, Viral hepatitis, Alcoholic liver diseases, Nonalcoholic fatty liver disease, Acute Liver Failure, Acute on Chronic Liver Failure, Kidney injury in Liver diseases, Liver regeneration, Liver transplant, and COVID-19 in liver disease patients.

Department of hepatology has given important contributions to developing guidelines for treatment of various liver diseases like AKI in cirrhosis and ACLF(2023), ACLF (2024); NCPF (2024)

APASL ACLF Research Consortium (AARC)- Largest Multinational Research Project in Liver Diseases across Asia

The APASL-ACLF Research Consortium (AARC), established in 2012 by the Asian Pacific Association for the Study of the Liver, is dedicated to advancing the understanding and management of Acute-on-Chronic Liver Failure (ACLF), a syndrome characterized by high short-term mortality and potential reversibility. The nodal center for AARC has been ILBS. AARC has developed one of the largest ACLF databases, with over 11869 cases from 122 centers across 24 Asia-Pacific countries. Its key contributions include defining ACLF criteria, developing a prognostic scoring system, introducing concepts like "golden therapeutic and transplant windows," and advocating plasmapheresis as a treatment. It has also focused on pediatric ACLF and fostered global collaboration to harmonize definitions and management practices. AARC continues to study ACLF's natural history and promote non-transplant interventions, striving to improve outcomes for patients across diverse regions.

The Kyoto Consensus on Acute-on-Chronic Liver Failure (ACLF) provides updated, evidence-based guidelines to unify global understanding and management of the condition. It defines ACLF as a rapid decline in liver function with high short-term mortality, triggered by acute hepatic insults in patients with chronic liver disease or cirrhosis, and proposes a unified definition combining regional criteria. The consensus outlines ACLF's progression from compensated cirrhosis to decompensation, recompensation, and regression, with systemic inflammation and immune dysfunction as key mechanisms. Prognosis and outcomes depend on early diagnosis, timely interventions like liver transplantation, and non-transplant strategies. Emphasizing global collaboration, it calls for standardized diagnostic criteria and further research to refine treatment protocols and understand disease mechanisms. The AARC work is co-ordinated under the supervision of Dr Vinod Arora and guidance of Dr Sarin.

Residents achievements in Academics:

EASL Congress 2025 [7-10 May 2025, Amsterdam, The Netherlands]The following abstracts were accepted by the organizing committee of the congress submitted by the respective investigators.

Dr. Akhil Deshmukh

• 1. Benchmarking spleen stiffness in assessing response to betablocker therapy for secondary prophylaxis of acute variceal bleed-BE-RESPONSE study (NCT0S 166317)

Dr. Vishnu Girish

• 1. Predictors of shock reversal and outcomes in acute-on-chronic liver failure with septic shock.

Dr. Omkar S Rudra

• 1. Effect of human albumin solution on coagulation parameters in decompensated cirrhosis (CoPA-D): an open-label randomized control trial.

AASLD The Liver Meeting 2025 [7-11 Nov 2025], Washington, DC, USA

Dr. Ayush Jain

• 1. Dapagliflozin can reduce the incidence of chronic kidney disease in Metabolic dysfunction associated steatotic liver disease associated cirrhosis patients with moderate ascites. A randomized controlled trial (DAPA-CLD).
• 2. Spectrum and outcomes of hepatitis a virusassociated acute liver failure: insights into extrahepatic manifestations and role of extracorporeal therapies
• 3. Pocus-guided fluid Resuscitation comparing Plasmalyte plus 20% albumin Vs 5% albumin in cirrhosis with Sepsis-induced hypotension: a Randomized controlled trial (ALPS PLUS)

Dr. Saurav Paul

• 1. Efficacy and safety of low-dose versus conventional dose albumin for prevention of acute kidney injury in cirrhosis and high-risk spontaneous bacterial peritonitis: a randomized controlled trial.

Dr. Phool Chand

• 1. Comparison of dexamethasone and n-acetylcysteine versus n-acetylcysteine alone in prevention of postembolization syndrome in patients with hepatocellular carcinoma following transarterial chemoembolization - randomized controlled trial.

Dr. Sudhir Verma

• 1. Dynamic changes in spleen stiffness predicts outcome of aclf patients by day-7 - a prospective study [NCT06069284]
• 2. Efficacy and safety of oral ibandronate in patients of liver cirrhosis with hepatic osteodystrophy: a randomized, double blind, placebo-controlled trial [NCT06022237]

Dr. lbrar Ahmed Khan

• 1. To study the efficacy of intravenous neostigmine in resolution of acute GI paralysis in critically ill cirrhosisprospective observational study (NCT- 06462872)

Dr. Jaifrin Daniel

• 1. Infection rather than bile acid levels predict mortality in alcohol Associated acute on chronic liver failure