1. Describe the creation of an interdisciplinary collaboration among hepatology, nephrology, critical care, and palliative care to improve serious illness care of patients with ACLF. 2. Enhance participants understanding of best-case/worst-case and time-limited trial communication frameworks to guide goals of care conversations for patients with ACLF. Acute-on-chronic liver failure (ACLF) is a dreaded complication of cirrhosis. When patients with ACLF develop acute kidney injury, the question of dialysis creates significant moral distress. To enhance communication and decrease distress, we created the SILK (Serious Illness Conversations in Liver and Kidney Failure) Collaborative. This interprofessional initiative optimizes conversations and resulted in a summit with over 100 multidisciplinary attendees. Acute-on-chronic liver failure (ACLF) is a dreaded complication in which patients with cirrhosis develop multisystem organ failure, carrying a short-term mortality of 40%-80% within 90 days. When patients with ACLF develop acute kidney injury, the decision whether to initiate dialysis leads to significant moral distress among patients, families, and the care team. Patients with ACLF often do not tolerate intermittent dialysis and require continuous renal replacement therapy in the intensive care unit (ICU). Many nephrologists do not recommend initiating dialysis for patients who are transplant-ineligible due to their high risk of death in the absence of transplantation. However, decision-making in the setting of ACLF is complex and unpredictable. Dialysis may possibly provide additional time for life closure or re-evaluation of transplant eligibility. Given this complexity, innovative models of multidisciplinary collaboration and communication are needed to improve the care of these patients. To enhance serious illness communication for patients with ACLF and address the moral distress surrounding dialysis decision-making, we created the SILK (Serious Illness Conversations in Liver and Kidney failure) Collaborative. This interprofessional initiative of nephrologists, hepatologists, critical care and palliative care clinicians began with the goal of optimizing goals of care conversations in ACLF using structured serious illness communication frameworks. This ongoing partnership resulted in a joint gastroenterology-nephrology summit in April 2023 with over 100 multidisciplinary attendees. During this summit we used a case-based format to share best-case/worst-case communication frameworks to support time-limited trials of dialysis for patients with ACLF. We also created the unique opportunity for a discussion between gastroenterology and nephrology colleagues about their distress regarding ACLF facilitated by palliative care. We plan to expand these trainings and pilot these frameworks in the ICU. This novel model of collaboration holds promise to improve serious illness care and decrease clinician distress. Interdisciplinary Teamwork / ProfessionalismCommunication [ABSTRACT FROM AUTHOR]