Maurice Stephan Michel

The Paris International Liver Meeting (January 19–21, 2026) brought together leading hepatology experts to discuss transformative advances in chronic liver disease management. The meeting highlighted pivotal developments reflecting the field's evolution from disease characterisation toward precision, mechanism‐based therapeutics. Metabolic dysfunction‐associated steatotic liver disease (MASLD) and its progressive form, metabolic dysfunction‐associated steatohepatitis (MASH), were highlighted, marking the transition to an era of approved disease‐modifying therapies. Resmetirom and semaglutide are now approved for MASH with F2–F3 fibrosis, with a robust pipeline generating anti‐fibrotic signals through FGF21 analogs, pan‐peroxisome proliferator‐activated receptor (PPAR) agonists, and incretin‐based dual and triple agonists. Non‐invasive tests have evolved beyond their original diagnostic role to enable prognostic stratification, screening of at‐risk populations, treatment selection, and monitoring of therapeutic response. This evolution is not limited to MASLD, but extends to other chronic liver diseases, including primary biliary cholangitis (PBC) and portal hypertension, as highlighted by the recommendations of the Baveno Consensus Workshops. Hepatitis B and D are moving toward functional cure strategies, with simplified HBV treatment algorithms based on fibrosis and viral load, supported by biomarkers for risk stratification and safe treatment discontinuation. In parallel, HDV management is transitioning from a severe disease to one with emerging suppressive and potential curative l through bulevirtide and novel HBsAg‐targeting and RNA‐silencing therapies, respectively. Management of PBC has advanced with novel PPAR agonists that improve cholestatic biochemistry and pruritus, supported by individualised risk stratification. However, significant treatment gaps persist, with fewer than half of eligible PBC patients receiving second‐line therapy, and fatigue remains a major unmet clinical need. Furthermore, effective pharmacotherapies for primary sclerosing cholangitis (PSC) remain a major challenge, and no approved disease‐modifying treatments are currently available. Finally, for patients with hepatocellular carcinoma (HCC), immunotherapy combinations can achieve unprecedented long‐term survival in selected populations of patients. Collectively, these advances define a new era of hepatology centered on precision medicine, earlier intervention, and mechanism‐driven therapeutic strategies.

Prior to holmium laser enucleation of the prostate (HoLEP) many patients have undergone short-term prostate biopsy (PB) to rule out the presence of prostate cancer. The aim of this study is to determine whether a short-term PB prior to HoLEP has an impact on the perioperative outcomes or complications of HoLEP. 734 consecutive patients treated with HoLEP at a tertiary care university hospital between January 2021 and July 2023 were retrospectively enrolled. Patients who had PB within 6 months before HoLEP were matched to patients who underwent PB more than 6 months or had no PB prior to HoLEP using propensity score matching (PSM) based on age, prostate volume (PV), prostate specific antigen (PSA), preoperative urinary tract infection (UTI) and surgeon. Perioperative parameters, such as operation time (OT), enucleation efficiency (EF), as well as complications according to the Satava classification, the Clavien-Dindo classification (CDC) and the Comprehensive Complication Index (CCI) were evaluated. A total of 206 patients were matched. Age, PV, PSA, as well as the presence of a preoperative UTI, and surgeons did not differ significantly between both groups after PSM. There were no significant differences in mean OT (75 vs. 81 min, p = 0.28) and EF (2.13 vs. 2.13 g/min, p = 0.99). No differences were noted regarding intraoperative (16 vs. 25, p = 0.16), or postoperative complications graded by CDC (p = 0.53) and CCI (p = 0.92). PB within 6 months preoperatively before HoLEP showed no effect on perioperative outcomes, or intra- and postoperative complications.

Background: Type 2 diabetes mellitus (T2DM) is a major risk factor for advanced liver disease. The aim of this prospective cohort study was to assess the prevalence and associated risk factors of liver fibrosis and cirrhosis in primary care centers participating in the diabetes disease management program (DMP) in Germany.Methods: A total of 175 participants with the diagnosis of T2DM were enrolled in two primary care centers. Steatotic liver disease (SLD; hepatic steatosis, ≥275 dB/m), fibrosis (≥8 kPa), and cirrhosis (≥15 kPa) were assessed non‐invasively using vibration‐controlled transient elastography. Multivariable logistic regression analysis was performed to identify clinical predictors of fibrosis and cirrhosis. The AUDIT questionnaire was used to screen for alcohol consumption, and a score ≥8 was considered harmful alcohol consumption.Results: The majority of participants were male (62%), and the median age was 66 years (interquartile range 59; 71). The median body mass index was 31.1 kg/m², with 58.9% of the participants being obese. Harmful alcohol consumption was prevalent in 8.0% and 20.0% of the entire cohort and in those with cirrhosis, respectively. The prevalence of SLD, fibrosis, and cirrhosis was 77.1%, 42.3%, and 12.0%, respectively. In multivariable logistic regression analysis, obesity, and harmful alcohol consumption were associated with the highest odds of fibrosis (odds ratio [OR] 5.198, 95% confidence interval [CI] 2.269–11.908) and cirrhosis (OR 5.615, 95% CI 1.274–24.756), respectively.Conclusion: The prevalence of fibrosis and cirrhosis in patients seen in the diabetes DMP in Germany is high. Obesity and harmful alcohol consumption increase the risk of fibrosis and cirrhosis in people with T2DM. Screening for advanced liver disease and associated risk factors within the DMP program may reduce the liver disease burden in this high‐risk population.

Objective: Early detection of hepatic steatosis in people with HIV (PWH) could prevent progression and inflammation. The aim was to develop and validate a multivariable risk prediction model for hepatic steatosis in German PWH. Design: In this cohort study, 282 PWH were prospectively enrolled, and hepatic steatosis was defined via controlled attenuation parameter (CAP; ≥275 dB/m) using vibration-controlled transient elastography. Methods: Three multivariable logistic regression models were conducted. Missing values were imputed with multiple imputation. Cut-offs were derived based on Youden-Indices. Performance was assessed via discriminatory and calibrative ability and accuracy via Brier Skill Score. Sensitivity, specificity, and predictive values were calculated. Internal validation was performed via bootstrapping. Results: The prevalence of hepatic steatosis was 35.3% (100/282). Univariate analyses revealed associations with age, waist circumference, BMI, hypertension, hyperlipidemia and gamma-gt. In multivariable analyses, male sex [odds ratio (OR) 2.07, 95% confidence interval (CI) 1.42–3.00, P = 0.001] and BMI (OR 1.27, 95% CI 1.18–1.36, P < 0.001) were identified as independent predictors of hepatic steatosis. The naive and optimism-corrected c-statistic of 79% showed a good discriminatory ability, the calibration was well with a slight tendency for overestimation for predicted probabilities above 70%. At the cutoff of 1.95, the specificity was 71% and the negative-predictive value 82.3%. Twenty-seven percent of the 282 patients would be misclassified, 17% as false positives and 10% as false negatives. Conclusion: The developed prediction model contributes to the lack of validated noninvasive tools to predict hepatic steatosis in people with HIV. Future studies should include more candidate predictors and externally validate the model.