A further evolution of this model has focused on early stage disease (‘Paris II criteria’),15 while a stratification based on ALP treatment response correlates biochemistry and histological progression (‘Toronto criteria’).18 The ‘Rotterdam criteria’ are focused towards liver function/stage, including albumin and bilirubin.17 Huet et al have used a different approach looking at portal hypertension.138 A total of 132 patients had porto-hepatic gradient and biochemical values measured at inclusion and every 2 years. The gene discussed is ALB; the disease is portal hypertension.