Baveno VIII - Advancing consensus in portal hypertension

: Since the first Baveno Consensus Conference in 1990, successive conferences held every 5 years have transformed the field of cirrhosis and portal hypertension, evolving from a focus on variceal bleeding to a pathophysiology-based framework centred on risk stratification, clinically significant portal hypertension (CSPH), and the prevention of decompensation. Building on this progress, the Baveno Cooperation, in collaboration with the Vascular Liver Disease Interest Group (VALDIG), convened an expert faculty to review the evidence published since Baveno VII and update clinical guidance for patients with advanced chronic liver disease (ACLD), portal hypertension, and vascular liver diseases. The Baveno VIII Consensus Conference, held in March 2026 in Baveno, Italy, was based on a structured consensus process across nine panels addressing key domains of ACLD, portal hypertension, and vascular liver diseases. Statements and recommendations were developed through iterative review of the evidence and voting among faculty, with strong consensus defined as >80% faculty agreement. A total of 272 statements and recommendations achieved strong consensus. Key areas included non-invasive risk stratification in compensated ACLD (cACLD), modifiers of steatotic liver disease, prevention of first and further decompensation, management of portal hypertensive bleeding and further decompensation, cirrhosis recompensation, and vascular liver diseases, including Budd-Chiari syndrome, portosinusoidal vascular disorder (PSVD) or non-cirrhotic portal fibrosis (NCPF), and portal vein thrombosis (PVT). The central role of CSPH and the expanding use of non-invasive tests were reaffirmed, and several diagnostic and prognostic cut-offs were revised. New to Baveno VIII is the inclusion of selected guidance for paediatric patients. Recommendations from previous conferences that were not specifically revised in Baveno VIII, such as those on hepatic venous pressure gradient (HVPG) measurement, remain valid. Finally, a research agenda identifying 153 priority topics is proposed.