Background: In patients with steatotic liver disease, metabolic dysfunction and alcohol-associated liver disease (MetALD) is a recently defined entity combining metabolic syndrome and moderate-to-high alcohol consumption. Its prognosis and outcomes compared with alcohol-associated liver disease (ALD) remain underexplored. The aim of the study was to assess liver recompensation (LR) between the 2 groups in patients with decompensated liver disease referred for liver transplant (LT) evaluation. Methods: We conducted a retrospective cohort study of 194 patients with decompensated liver disease, diagnosed as MetALD or ALD, and referred for LT evaluation between October 2021 and August 2023 at a single U.S. transplant center, and compared the outcomes between the 2 groups. The diagnoses of MetALD and ALD were based on the Delphi consensus definitions. Results: Of the 194 patients, 135 (70%) had ALD and 59 (30%) had MetALD. Baseline characteristics showed significantly higher BMI (31 vs. 28 kg/m ² , p =0.001), chronic kidney disease (32% vs. 17%, p =0.025), and lower Karnofsky scores (51 vs. 62, p =0.014) in the MetALD group. While no statistical difference was found in listing and LT rates between groups, LR occurred significantly less in MetALD compared with ALD (3% vs. 18%, p =0.006). On multivariable analysis, MetALD independently predicted lower LR (HR 0.21, 95% CI: 0.05–0.91). Hypertension (HR 0.38, 95% CI: 0.16–0.89) and increasing BMI (HR 0.91, 95% CI: 0.84–0.99) were also significantly associated with lower LR. While overall mortality was higher in the MetALD group (42% vs. 26%, p =0.029), MetALD was not an independent mortality predictor after adjustment. Conclusions: Compared with ALD, MetALD is associated with significantly lower LR in patients with decompensated liver diseases referred for LT evaluation.

Background: Despite evidence discouraging contralateral prophylactic mastectomy (CPM) in average-risk patients, its use is increasing globally. While well-studied in Western settings, little is known about the factors influencing CPM decisions in the Middle East and North Africa (MENA) region. This study explores clinical, psychosocial, and communication-related factors associated with CPM choices among women with early-stage breast cancer. Methods: We conducted a retrospective study of 253 early-stage breast cancer patients who underwent mastectomy, with or without CPM, at the American University of Beirut Medical Center. Clinical and demographic data were extracted from medical records, and decision-making factors were assessed through tailored patient questionnaires. Associations were analyzed using chi-square tests and multivariable logistic regression. Results: Of the 253 women included in the study, 37 underwent CPM, while 216 had unilateral mastectomy (UM). Compared to the UM group, women who chose CPM were more likely to have a college education (96.9% vs. 57.6%, p < 0.001), be employed (69.7% vs. 41.3%, p = 0.002), and report a family history of breast cancer (55.6% vs. 30.2%, p = 0.003). Immediate reconstruction was significantly more common among CPM patients (67.6% vs. 16.4%, p < 0.001), and the 30-day rehospitalization rate was also higher (16.2% vs. 6.1%, p = 0.031). Women in the CPM group were more likely to prioritize extending life (84.6% vs. 56.7%, p = 0.007) and achieving peace of mind (80.8% vs. 49.3%, p = 0.003). Although all CPM patients cited risk reduction as a primary motivator, only 46.2% believed they had a lower recurrence risk than their peers (vs. 20% of UM patients, p < 0.001). Decisions to undergo UM were more frequently influenced by physicians’ recommendations (95.3% vs. 53.8%, p < 0.001), whereas CPM decisions appeared to be more patient-driven. Additionally, CPM patients reported more negative expectations and higher dissatisfaction with pain (57.7% vs. 32.0%, p = 0.012) and reconstructive outcomes (54.5% vs. 27.5%, p = 0.035). Conclusions: In this first study from the MENA region exploring CPM decision-making, choices were largely driven by personal preferences rather than clinical risk. These findings highlight the need for improved risk communication, shared decision-making, and broader integration of genetic counseling in surgical planning.