Background Understanding the ethnic molecular subtype characteristics of breast cancer (BC) in Saudi women is crucial for providing comprehensive prognostic information and optimizing patient outcomes, making it essential to study their distribution and impact on survival. Methods This hospital-based cohort study analyzed clinic–pathological data from 1,035 Saudi women diagnosed with invasive BC and followed for 12 years, at King Faisal Specialist Hospital & Research Center. Cancers were classified into four molecular subtypes: luminal A, luminal B, human epidermal growth factor receptor 2 (HER2)-enriched, and triple-negative. Survival outcomes were assessed using Kaplan–Meier survival curves and Cox proportional hazard models. Results Luminal A was the most common molecular subtype (41.7%), followed by luminal B (23.4%), triple-negative (19.5%), and HER2-enriched (15.4%). Age at diagnosis, menopause, and tumor grade were significantly associated with subtypes (p < 0.05). Survival outcomes varied significantly (p = 0.0202), with luminal A and B showing the highest 5-year survival rates (~ 83%), triple-negative at 76.4% (hazard ratio: 1.55), and HER2-enriched tumors had the lowest at 69.1%, with a 1.75-fold higher risk of death. Advanced-stage cancers (III and IV) were strongly associated with increased mortality, with hazard ratios of 2.5 and 7.6, respectively, compared to early-stage disease. Conclusions Molecular subtypes and stage at diagnosis are key predictors of mortality in Saudi women with BC. The poor outcomes for HER2-enriched and TNBC subtypes highlight the need for timely diagnosis and targeted treatments, emphasizing the importance of personalized care and addressing ethnic variations in BC diagnosis.

Background/Objectives: Acute-on-chronic liver failure (ACLF) is a severe syndrome in chronic liver disease (CLD) patients, characterized by multi-organ failure and high mortality. Living donor liver transplantation (LDLT) is vital in donor-scarce areas. This study compares baseline characteristics, perioperative complications, and long-term survival between ACLF and non-ACLF patients, emphasizing etiology, ACLF grading, and graft factors. Methods: Data from a prospective registry of 591 adult LDLT recipients (2019–2023) were analyzed. ACLF was defined by EASL-CLIF (multi-organ failure, grades 1–3) and APASL (jaundice/coagulopathy with complications) criteria, evaluated at initial assessment and within 24 h pre-LDLT. Results: ACLF patients (n = 101, 17.1%) showed higher MELD-Na (27 vs. 20, p < 0.001), bilirubin (6.84 vs. 1.75 mg/dL, p < 0.001), creatinine (108 vs. 70.5 μmol/L, p < 0.001), metabolic/genetic etiologies (9.9% vs. 2.8%, p = 0.001), and chronic kidney disease (23.7% vs. 8.1%, p < 0.001), and lower HCC rates (11.8% vs. 29.6%, p < 0.001). GRWR was marginally lower in ACLF patients (0.59 vs. 0.66, p = 0.10). The ACLF group had elevated infection (27.7% vs. 10.4%, p < 0.001), bleeding (14.9% vs. 6.3%, p = 0.004), and biliary complications (15.8% vs. 7.8%, p = 0.010), with longer ICU (5 vs. 3 days, p < 0.001) and hospital stays (33.66 vs. 20.7 days, p = 0.036). Five-year overall survival was reduced in ACLF patients (log-rank p = 0.001), worsening with grade (EASL-CLIF grade 3: 55% vs. 81% for no ACLF, p = 0.002). Graft survival was also lower (75% vs. 85%, p = 0.02). Multivariable analysis identified chronic kidney disease as an independent mortality predictor (HR 2.09, 95% CI 1.11–3.95, p = 0.023). Conclusions: LDLT for ACLF involves higher perioperative risks and poorer long-term survival than non-ACLF patients, with outcomes deteriorating by ACLF grade. Chronic kidney disease independently predicts mortality. Timely LDLT is essential in donor-limited regions.

The Sundaram Acute-on-Chronic Liver Failure-Liver Transplant Mortality (SALT-M) score predicts 1-year posttransplant mortality in patients with severe acute-on-chronic liver failure (ACLF) undergoing deceased donor liver transplantation. Its performance in living donor liver transplantation (LDLT) is unknown. We externally validated SALT-M in 2 independent ACLF-LDLT cohorts: King Faisal Specialist Hospital and Research Centre (KFSHRC), Riyadh (n=121), and a global International LDLT Registry cohort (n=57). Discrimination (AUROC with 95% CI), calibration (observed-to-expected [O:E] ratio, calibration slope, and intercept), and association with observed outcomes were assessed overall and, in the KFSHRC cohort, separately in ACLF grade 1 and severe ACLF (grades 2–3). In the KFSHRC cohort, ACLF grade was 1 in 47.9%, 2 in 43.0%, and 3 in 9.1%; 1-year mortality was 14.9% (global cohort 21.1%). SALT-M predicted ≤30% mortality in 95.9% of the KFSHRC and 98.2% of the global cohort. Discrimination was limited and statistically inconclusive: AUROC 0.56 (95% CI: 0.40–0.72) overall, 0.62 (0.42–0.81) in severe ACLF, and 0.51 (0.25–0.76) in ACLF-1. Calibration-in-the-large was acceptable (O:E 1.18, 95% CI: 0.74–1.87), but the calibration slope was shallow (0.16). None of the 5 SALT-M components was associated with 1-year mortality; white blood cell count (OR: 1.14, p =0.03) and female sex (OR: 3.49, p =0.02) were associated with 1-year mortality. MELD-Na and MELD 3.0 were higher among nonsurvivors in the global cohort ( p =0.03 and p =0.02, respectively). In LDLT-dominant ACLF cohorts—evaluated largely outside the severe-ACLF population for which SALT-M was derived—discrimination could not be confirmed, reflecting profound spectrum restriction and few outcome events rather than demonstrated model failure. SALT-M should be applied cautiously as an adjunctive risk-stratification tool, not as a universal threshold for transplant candidacy.