Background: Copper is an essential trace element involved in antioxidant defense and mitochondrial function. Evidence suggests that copper homeostasis may also influence metabolic liver diseases. We investigated the association between hepatic copper levels (HCLs) and liver-related outcomes among patients with Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD). Methods: In this retrospective cohort study, we analyzed 215 MASLD patients who underwent liver biopsy with copper quantification. Patients were categorized based on hepatic copper content; normal < 50 vs. high ≥ 50 μg/g dry tissue (165 vs. 50 patients, respectively). The primary outcomes were progression in non-invasive fibrosis score (FIB-4) and incidence of clinical events (cirrhosis, liver transplantation, cardiovascular events or death) during a median follow-up of 4.9 ± 4.2 years. Multivariable linear and logistic regression models were adjusted for metabolic and demographic confounders. Results: Both liver copper groups shared similar baseline characteristics. High hepatic copper levels independently predicted higher FIB-4 scores at the end of follow-up in the fully adjusted linear regression model (β = 0.41; 95% CI: 0.05–0.76; p = 0.026). Logistic regression confirmed that high HCLs were associated with significant FIB-4 deterioration (OR = 41.3; 95%; p = 0.008). Kaplan–Meier analysis revealed significantly reduced overall survival among patients with high HCLs (Log-Rank p = 0.034), and multivariable Cox regression showed a markedly increased mortality risk (HR = 18.51; 95%; p = 0.032). Subgroup analyses highlighted greater risk among females, patients with diabetes or dyslipidemia, and individuals of Arab ethnicity. Conclusions: Elevated hepatic copper levels are associated with long term worsened liver fibrosis and higher mortality in MASLD. These findings support hepatic copper as a potential nutritional biomarker for risk stratification. Further studies are needed to explore copper modulation as a therapeutic target in MASLD.

Background: Nephrectomy in patients with polycystic kidney disease (PKD) is typically arduous due to the considerable size of the kidneys. The laparoscopic method has arisen as a minimally invasive substitute for open surgery. Nonetheless, conventional laparoscopic methods may be inadequate for tackling the distinct anatomical complexities of a large polycystic kidney. This study presents a unique method, “the hilum first technique”, specifically designed for nephrectomy in patients with PKD, emphasizing its safety and efficacy in addressing this intricate condition. Methods: A retrospective analysis of patients with PKD who underwent minimally invasive nephrectomy using “the hilum first technique” at our hospital between 2020 and 2025. Data on operative time, blood loss, conversion rates, hospital stay, and outcomes were analyzed to evaluate this technique’s safety and efficacy. Results: Minimally invasive nephrectomy using the “hilum first technique” was successfully performed in 16 cases; the mean age of patients was 56.3 years. Two of which were robot-assisted, in which one of them, a bilateral nephrectomy was done, with no conversions to open surgery, even for huge kidneys. The mean operative time was 159.6 min, with an estimated blood loss of 50 mL. Postoperatively, the median duration of hospital stay was 4 days (range: 3–10 days), and 75% of patients experienced no complications. Three patients (18.7%) were readmitted within 30 days due to surgical site infection, subcutaneous hematoma, and pneumonia. Seven patients (43.7%) underwent kidney transplantation within a median duration of 132 days post-nephrectomy. Conclusions: This retrospective study, although limited by a small sample size, demonstrated significant promise as a novel strategy for tackling the challenges of huge polycystic kidneys. The findings suggest its feasibility and safety, although further validation is required.

Background: Acute tubular necrosis (ATN) and acute rejection are the principal parenchymal causes of early kidney allograft dysfunction, and biopsy is the reference standard for distinguishing them. We assessed 99mTc-MAG3 scintigraphy against biopsy. Methods: Single-center retrospective study of transplants (2016 to 2025) scanned within 90 days for suspected graft dysfunction: 42 transplants in 41 recipients, 10% of 420 screened. Accuracy was calculated only in the 25 with a paired biopsy, with exact 95% confidence intervals (CIs). Because biopsy was performed on clinical indication and not in all patients, verification bias was quantified by Begg–Greenes correction and extreme-case bounds. Results: Scintigraphy was performed a median of 8 days after transplantation; 69% had delayed graft function. Scans were read as ATN in 31 (74%), normal in seven (17%), rejection in three (7%) and obstruction in one; biopsy showed ATN in 15, rejection in six and normal histology in four. For ATN, sensitivity was 14/15 (93.3%; CI 68.1 to 99.8), specificity 7/10 (70.0%; 34.8 to 93.3) and positive predictive value 14/17 (82.4%; 56.6 to 96.2). For rejection, sensitivity was 3/6 (50.0%; 11.8 to 88.2) and specificity 19/19 (100%; 82.4 to 100), the predictive value of three positive scans being uninformative (CI 29.2 to 100). Correcting for verification placed ATN specificity between 29.2% and 76.9% and rejection sensitivity between 13.0% and 50.0%. Conclusions: Scintigraphy rarely missed biopsy-proven ATN but was not specific and identified only half of the rejection episodes. These estimates rest on small numbers in a clinically selected population; biopsy remains necessary whenever rejection is suspected, and they do not apply to routine or protocol scintigraphy.

Background: Recipient hepatectomy during orthotopic liver transplantation (OLT) is frequently complicated by severe bleeding due to portal hypertension and collateral circulation. The Pringle maneuver’s benefit in this setting remains uncertain. Methods: We retrospectively analyzed data from 141 adults who underwent primary deceased-donor OLT at a single center between January 2020 and June 2026. A routine intermittent Pringle maneuver was introduced in 2023; 79 subsequent recipients comprised the Pringle group, while 62 earlier recipients served as historical controls. Multivariable regression and inverse probability of treatment weighting (IPTW) were used to address confounding, and temporal trends within each period were examined. Results: Indication for transplantation, markers of hepatic decompensation, and extended-criteria donor status did not differ between groups. Compared with controls, the Pringle group required fewer packed red blood cell units (median 2 {IQR 0–4} vs. 3 {1–5}; p = 0.046), fresh frozen plasma units (4 {0–6} vs. 4 {3–8}; mean 4.1 vs. 6.9; no plasma transfused in 30.8% vs. 13.6%; p = 0.005), and total blood products (5 {0–9} vs. 8 {4–14}; p = 0.009). Recipient hepatectomy was shorter (129 {105–165} vs. 177 {146–208} minutes; p < 0.001), and postoperative bleeding (2.5% vs. 22.6%; p < 0.001), biliary leak (2.5% vs. 11.3%; p = 0.043), and early allograft dysfunction (EAD; 6.3% vs. 29.0%; p < 0.001) were less frequent. After adjustment, the Pringle maneuver remained associated with shorter hepatectomy (time ratio 0.76; 95% CI 0.67–0.87), reduced fresh frozen plasma (IRR 0.60; 0.40–0.91) and total blood product use (IRR 0.61; 0.40–0.92), and lower odds of postoperative bleeding (OR 0.04; 0.01–0.25), biliary leak (OR 0.13; 0.02–0.63), and EAD (OR 0.14; 0.04–0.58). Packed red blood cell transfusion was nonsignificant after adjustment (IRR 0.70; 0.43–1.12). IPTW yielded consistent findings. Overall survival did not differ (p = 0.885). Conclusions: In this historical-control study, routine intermittent Pringle maneuver was associated with improved operative efficiency, lower transfusion requirements, and fewer early complications without affecting survival; given the retrospective design and the modest absolute differences in transfusion, these findings require prospective confirmation.