From EASL 2026: What Hepatology Still Needs to Solve

Why It Matters

Addressing MASH cirrhosis and screening gaps could slash liver‑related mortality and transplant demand, while unlocking new therapeutic markets for pharma and biotech firms.

Key Takeaways

• MASH cirrhosis drives most liver transplants in US and Europe
• Fibrosis reversal rates of 15‑20% possible with potent combos
• Screening algorithms exist but lack population‑level implementation
• Alcohol‑related liver disease remains chronically underfunded
• Hepatitis C cure model suggests potential for steatotic disease therapies

Pulse Analysis

Steatotic liver disease, now the leading indication for liver transplantation in both Europe and the United States, reflects a convergence of metabolic dysfunction, alcohol use, and viral hepatitis. The surge in MASH cases mirrors rising obesity and diabetes rates, pushing more patients into advanced fibrosis and cirrhosis. This epidemiologic shift forces health systems to confront higher costs, longer hospital stays, and a growing need for transplant resources, underscoring why the hepatology community is prioritizing disease‑modifying solutions.

Therapeutic innovation is at a crossroads. While direct‑acting antivirals eradicated hepatitis C as a transplant driver, MASH lacks an equivalent breakthrough. Recent trial data suggest that combination regimens can achieve fibrosis‑reversal rates of 15‑20%, hinting at a paradigm shift from disease stabilization to reversal. Industry players are exploring multi‑targeted agents, including FXR agonists, ACC inhibitors, and emerging gene‑editing approaches, to replicate the hepatitis C success story. The challenge lies in demonstrating durable efficacy in cirrhotic patients and navigating regulatory pathways for combination therapies.

Screening remains the most actionable lever. Validated non‑invasive algorithms—such as FibroScan‑based scores—can identify at‑risk individuals before irreversible damage occurs, yet their deployment is fragmented across health systems. Policymakers and payers must incentivize widespread adoption, integrating liver health metrics into routine primary‑care visits. Simultaneously, chronic underfunding of alcohol‑related liver disease and rare cholangiopathies hampers research pipelines. Aligning public‑private investment with the demonstrated burden of steatotic disease could accelerate gene‑therapy trials and broaden therapeutic options, ultimately reducing the global liver disease toll.