Baveno VIII - Advancing Consensus in Portal Hypertension

Since the first Baveno consensus conference in 1990, successive conferences every 5 years have transformed the field of cirrhosis and portal hypertension evolving from a focus on variceal bleeding to a pathophysiology-based framework centered on risk stratification, clinically significant portal hypertension (CSPH), and 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 evidence 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 in ACLD and vascular liver diseases and complications related to portal hypertension. Statements and recommendations were developed through iterative review of the evidence and voting, 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, 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 key role of CSPH and the expanding use of non-invasive tests was confirmed and cutoffs revised. New to Baveno VIII is the inclusion of selected guidance for paediatric patients. Recommendations from prior conferences that were not specifically revised in Baveno VIII remain valid, such as those on hepatic venous pressure gradient (HVPG) measurement. A research agenda identifying 153 priority topics is proposed.