Acute-on-chronic liver failure (ACLF) is a condition associated with high mortality in the absence of liver transplantation. There have been various definitions proposed worldwide. The first consensus report of the working party of the Asian Pacific Association for the Study of the Liver (APASL) set in 2004 on ACLF was published in 2009, and the "APASL ACLF Research Consortium (AARC)" was formed in 2012. The AARC database has prospectively collected nearly 10,500 cases of ACLF from various countries in the Asia-Pacific region. This database has been instrumental in developing the AARC score and grade of ACLF, the concept of the 'Golden Therapeutic Window', the 'transplant window', and plasmapheresis as a treatment modality. Also, the data has been key to identifying pediatric ACLF. The European Association for the Study of Liver-Chronic Liver Failure (EASL CLIF) and the North American Association for the Study of the End Stage Liver Disease (NACSELD) from the West added the concepts of organ failure and infection as precipitants for the development of ACLF and CLIF-Sequential Organ Failure Assessment (SOFA) and NACSELD scores for prognostication. The Chinese Group on the Study of Severe Hepatitis B (COSSH) added COSSH-ACLF criteria to manage hepatitis b virus-ACLF with and without cirrhosis. The literature supports these definitions to be equally effective in their respective cohorts in identifying patients with high mortality. To overcome the differences and to develop a global consensus, APASL took the initiative and invited the global stakeholders, including opinion leaders from Asia, EASL and AASLD, and other researchers in the field of ACLF to identify the key issues and develop an evidence-based consensus document. The consensus document was presented in a hybrid format at the APASL annual meeting in Kyoto in March 2024. The 'Kyoto APASL Consensus' presented below carries the final recommendations along with the relevant background information and areas requiring future studies.

急性慢性肝衰竭（ACLF）是一种在没有肝移植的情况下与高死亡率相关的疾病。世界范围内提出了各种不同的定义。2004年成立的亚太肝脏研究协会（APASL）工作组关于ACLF的第一份共识报告于2009年发表，2012年成立“APASL ACLF研究联盟（AARC）”。AARC数据库已从亚太地区各国收集了近10500例ACLF病例。该数据库有助于ACLF的AARC评分和分级、“黄金治疗窗口”、“移植窗口”的概念以及血浆置换作为一种治疗方式。此外，这些数据也是确定儿童ACLF的关键。来自西方的欧洲肝脏-慢性肝衰竭研究协会（EASL CLIF）和北美终末期肝病研究协会（NACSELD）加入了器官衰竭和感染的概念，作为ACLF和CLIF-序贯器官衰竭评估（SOFA）和NACSELD评分的预测指标。中国重型乙型肝炎研究小组（COSSH）增加了COSSH-aclf标准来治疗伴有和不伴有肝硬化的乙型肝炎病毒-aclf。文献支持这些定义在确定高死亡率患者的各自队列中同样有效。为了克服分歧，形成全球共识，APASL主动邀请全球利益相关者，包括来自亚洲、EASL和AASLD的意见领袖，以及其他ACLF领域的研究人员，共同确定关键问题，制定一份基于证据的共识文件。该共识文件以混合格式在2024年3月于京都举行的APASL年会上提交。下面提出的“京都APASL共识”载有最终建议以及相关背景信息和需要未来研究的领域。