The present version of the American Association for the Study of Liver Diseases (AASLD) Position Paper represents a thorough overhaul from the previous version of 2005. In addition to two new additional authors, the revision includes updated expert opinion regarding (1) etiologies and diagnosis, (2) therapies and intensive care management, and (3) prognosis and transplantation. Because acute liver failure (ALF) is an orphan disease, large clinical trials are impossible and much of its management is based on clinical experience only. Nonetheless, there are certain issues that continue to recur in this setting as well as growing consensus (amidst innovation) regarding how to maximize the ALF patient’s chance of recovery. The changes in ALF management are not global in nature, but are more consistent with incremental experience and improvements in diagnosis and intensive care unit management.