Background: Hepatitis B Virus (HBV) remains a major global health challenge, with significant morbidity and mortality associated with chronic infections. Methods: This study examines the epidemiology, screening, and risk factors associated with HBV in Romania, focusing on a comprehensive national screening program, LIVE(RO)2, involving 320,000 individuals (majority of them considered vulnerable population). A questionnaire was used to collect information on the potential risk factors for HBV transmission. Results: The overall prevalence rate of HBV chronic infection among all the participants tested was 1.67% (confidence interval: 1.63–1.72%), with significant differences (p = 0.0001) between participants from the main geographical regions of residence (North-East 1.89%, South 1.38%, South-East 2.06%, and South-West 1.54%). Male persons aged 30–49 or 60–69 years old, from the rural and Eastern parts of Romania and non-Romanian ethnia, with a low level of education, unvaccinated, not married, unemployed, with family members with hepatitis, with personal histories of blood or blood product transfusion, surgical interventions, tattooing, hospitalizations, imprisonment, haemodialysis, unsafe sexual contacts, or with sexual transmitted infectious diseases were risk factors associated with HBsAg seropositivity. Conclusions: Our findings highlight significant demographic and epidemiological patterns of reduced HBV prevalence even in vulnerable persons, as well as modified risk factors and the impact of socio-economic factors.

Background: Primary sclerosing cholangitis (PSC) is an immune-mediated disease that has an unfavorable prognosis and needs a liver transplant (LT). The aim of this paper was to show the usefulness of the Majoie classification on magnetic resonance cholangiopancreatography (MRCP) images in assessing the prognosis in adult patients with PSC. Methods: Our work presents a retrospective monocentric study performed on 64 adult patients with PSC of the large bile ducts. Two radiologists evaluated the MRCP of diagnosis and calculated MRCP scores using the Majoie classification. Liver-related outcome (LT or liver-related death) was marked as a primary endpoint. Results: Univariate analysis showed that patients with more severe lesions (sum score of intrahepatic and extrahepatic ducts > 3) had a lower age at diagnosis, of 37.2 years, complicated with liver cirrhosis (53.1% of patients) and recurrent cholangitis (28.1%) p < 0.05, without significant differences in mortality, association with IBD or LT. Concordance analysis between MRCP prognostic scores and progression to a PSC-related event showed a moderate relationship (c-statistic 0.662), and a good AUROC was observed for the UKPSC score (0.893) and the MRS (0.936). Conclusions: In the study, we observed a good correlation between the imaging scores based on the Majoie classification and the evolution of the patients. These scores were outperformed by the UKPSC, MRS, and PREsTo clinical models. Their utility was best in predicting recurrent cholangitis.

Background: Hepatitis B (HBV) and Delta (HDV) virus infections pose critical public health challenges, particularly in Romania, where HDV co-infection is underdiagnosed. Methods: This study investigates the epidemiology, risk factors, and clinical outcomes of HBV/HDV co-infection in vulnerable populations, leveraging data from the LIVE(RO2) program. Conducted between July 2021 and November 2023, the program screened 320,000 individuals across 24 counties, targeting socially disadvantaged groups such as rural residents, the Roma community, and those lacking health insurance. Results: Among 6813 hepatitis B surface antigen (HBsAg)-positive individuals, HDV antibody prevalence was 4.87%, with active replication confirmed in 75.6% of HDV-positive cases. Regional disparities emerged, with higher HDV prevalence and replication rates in the Eastern region compared to the South. HDV-positive individuals were more likely to be younger, male, and from rural or socioeconomically disadvantaged backgrounds. Clinically, HDV co-infection correlated with increased liver stiffness, advanced fibrosis stages, and lower steatosis levels compared to HBV mono-infection. Psychiatric comorbidities were more prevalent among HDV-positive patients, highlighting the need for integrated care. Conclusions: This study underscores the urgent need for targeted public health interventions, including enhanced screening, education, and access to novel antiviral therapies like bulevirtide to address the significant burden of HBV/HDV co-infection in Romania.

Background: Primary Biliary Cholangitis (PBC) is a chronic autoimmune liver disease, characterized by cholestasis and fibrosis. Ursodeoxycholic acid (UDCA) is the first-line treatment for normalizing markers, slowing progression, and improving outcomes. Various criteria, including Paris II, POISE, and Barcelona, along with scores like GLOBE, UK-PBC, and URS, help assess response and prognosis. The aim of our study was to evaluate the patient’s profile and assess treatment response to UDCA. Methods: We conducted a retrospective study of 276 patients diagnosed with PBC, evaluated between 2011 and 2024 at Fundeni Clinical Institute in Bucharest. Of these, 117 patients were assessed for UDCA response at 12 months. Demographic, clinical, and biochemical data were collected. Treatment response was evaluated using established criteria and prognostic scores. Logistic regression analysis was used to identify significant predictors of treatment response, while ROC curves assessed predictive capabilities for liver-related outcomes (LRO) and UDCA biochemical response. Results: The cohort primarily consisted of women (95.28%) with a mean age at diagnosis of 53.89 years (95% CI, 52.43–55.34). 40.5% of patients developed liver cirrhosis during follow-up. At 12 months, the response rates to UDCA therapy were 44.44%, 41.88%, and 52.14% according to the Paris II, POISE, and Barcelona criteria, respectively. Biochemical improvement was significant, particularly the reduction of alkaline phosphatase (ALP) below 1.67× the upper limit of normal, which was observed in 62.39% of patients. ROC analysis demonstrated robust predictive capabilities, with UK-PBC (AUROC 0.899) and GLOBE (AUROC 0.867) scores accurately predicting LRO. A lower age at diagnosis, higher ALP values at diagnosis, and absence of sp100 were factors associated with non-response. Conclusions: This study is one of the first detailed analyses of PBC patients in Romania, examining population-specific characteristics and UDCA response rates. Low response rates at 12 months highlight the need for longer follow-up and the exploration of second-line therapies.

Hepatocellular carcinoma (HCC), a common consequence of chronic liver disease, ranks among the most prevalent cancers globally and contributes significantly to cancer-related mortality. Liver fibrosis is intimately associated with hepatic function and the likelihood of future HCC occurrence. Despite the fact that liver biopsy continues to be the gold standard for diagnosing fibrosis, its utility is hindered by cost and invasiveness, along with patient unease, procedural rejection, and potential adverse effects. Liver elastography has become a leading noninvasive means of assessing tissue stiffness with considerable diagnostic precision. Malignant tumors generally exhibit higher cellularity in comparison to benign ones, resulting in increased stiffness. Elastography techniques capitalize on alterations in tissue elasticity stemming from specific pathological or physiological processes. Technological innovations, such as advanced ultrasound imaging and artificial intelligence (AI)-integrated systems, are paving the way for enhanced diagnostic accuracy and risk prediction. Recent research underscores the potential of elastography in managing HCC patients, presenting novel clinical applications, including prediction of HCC development, differentiation between malignant and benign liver lesions, evaluating treatment response, and forecasting recurrence post-treatment, though certain findings remain contentious. Therefore, this review aims to sum up the latest advancements in liver elastography for HCC patients, outlining its applications while addressing existing limitations and avenues for future progress.

Background/Objectives: Chronic hepatitis B virus (HBV)/hepatitis D virus (HDV) coinfection is a major cause of cirrhosis and hepatocellular carcinoma (HCC) and remains a disproportionately frequent indication for liver transplantation (LT) in Romania, one of the highest-HDV-prevalence countries in Europe, yet patient-level outcome data from this high-burden Eastern European setting are lacking. We report the ten-year outcomes of LT for HBV/HDV-related cirrhosis in a large single-centre Romanian cohort. Methods: We retrospectively analysed 236 adults transplanted for HBV/HDV-related cirrhosis at a single tertiary centre. Survival was estimated by the Kaplan-Meier method and predictors were assessed by Cox regression. HBV, HDV and HCC recurrence, and anti-HBs kinetics under combined hepatitis B immunoglobulin (HBIG)/nucleos(t)ide-analogue prophylaxis, were analysed. Results: Over a median follow-up of 8.1 years (maximum 14.4), overall survival was 89.8%, 82.8% and 79.5% at 1, 5 and 10 years; among 90-day survivors, conditional survival reached 86.9% at 10 years. Under an “on-demand” low-dose HBIG protocol combined with nucleos(t)ide analogues, HBV recurrence (HBsAg reappearance) occurred in 4.7% and HDV recurrence in 1.7% of patients, without graft dysfunction or death attributable to viral recurrence; anti-HBs titres stabilised at 120–140 IU/L beyond the first year, with approximately 60% of patients maintaining levels above 100 IU/L long-term. HBsAg reappearance occurred exclusively in HCC recipients (11/87 vs. 0/149, p < 0.001) and clustered in patients with tumour recurrence (9/17 vs. 2/70, p < 0.001), preceding the radiological diagnosis of recurrence in six of the nine patients concerned. Mortality was concentrated in the perioperative period (90-day mortality 8.5%), driven mainly by sepsis and surgical complications, and recurrent HCC was the most common recorded cause of late death. Neither the severity of liver disease at listing (MELD, ALBI) nor any viral variable was associated with survival; HCC as indication was associated with survival in univariable analysis and beyond-Milan tumour burden independently (HR 2.74, 95% CI 1.36–5.54). Conclusions: LT for HBV/HDV-related cirrhosis achieves excellent long-term survival and very low viral recurrence under combined prophylaxis, even in this HDV-hyperendemic setting; beyond the perioperative period, viral factors were not associated with survival, whereas beyond-Milan tumour burden was associated with worse survival in one of the sensitivity analyses. In this HBV/HDV cohort, HBsAg reappearance after transplantation for HCC was associated with tumour recurrence and may be regarded as a warning sign prompting oncological reassessment; whether it represents a true early marker requires prospective validation.