End-stage liver disease continues to present a major clinical challenge, for which liver transplantation (LT) remains the only treatment capable of restoring long-term survival and organ function. Despite advancements in perioperative care and surgical techniques, predicting post-transplant outcomes remains an area of considerable uncertainty. The neutrophil percentage-to-albumin ratio (NPAR), derived from standard blood tests, has emerged as a marker reflecting both systemic inflammation and nutritional status. While NPAR has shown prognostic potential in various liver-related conditions, its role in LT has not been fully clarified. We retrospectively analyzed data from 167 adult patients who underwent LT between 2012 and 2022. Patients were stratified by post-transplant survival status. Preoperative variables – including serum albumin, model for end-stage liver disease (MELD) score, and NPAR – were compared between survivor and non-survivor groups. Receiver operating characteristic analyses were performed to evaluate the predictive performance of these parameters individually and in combination. Significant differences in albumin, total bilirubin, MELD score, and NPAR were observed between survivor and non-survivor groups ( P < .05). Individually, both NPAR and MELD demonstrated limited predictive value (AUC = 0.387 and 0.383, respectively). However, their combined application significantly improved discriminatory ability (AUC = 0.654, P = .007), suggesting a complementary interaction. Although NPAR alone is not a strong standalone predictor of post-transplant survival, its integration with the MELD score enhances prognostic accuracy. These findings support the role of NPAR as an adjunct parameter in refining pre-transplant risk assessment.

Objective: The primary aim of this study was to evaluate the predictive value of pre-transplant Alpha-fetoprotein (AFP) levels combined with tumor morphological features (number, size, and localization) on early and late hepatocellular carcinoma (HCC) recurrence following liver transplantation. The secondary aim was to assess the impact of these variables, along with tumor differentiation, vascular invasion, and response to pre-transplant locoregional therapies, on overall survival and postoperative mortality.Method: A total of 77 patients (M/F: 68/9, mean age 62.6) who underwent liver transplantation for HCC were retrospectively analyzed. Preoperative AFP levels, AFP scores, radiological tumor burden, and explant pathology results were retrieved from medical records. Primary endpoints were overall recurrence, early (12-month) and late (24-month) recurrence rates, and overall survival. Mann-Whitney U test and Kruskal-Wallis H test were used for statistical analysis.Results: During a mean follow-up of 1305 days, the overall recurrence rate was 19.48% (n=15). Patients with recurrence had significantly larger maximum tumor diameters (35.13 ± 11.96 mm vs. 28.03 ± 17.34 mm; p=0.048) and a higher number of tumor nodules (3.67 ± 3.29 vs. 2.03 ± 1.68; p=0.022). Pre-transplant baseline AFP levels were significantly higher in patients who developed recurrence within 24 months compared to those who did not (146.99 ng/mL vs. 42.11 ng/mL; p=0.049). Furthermore, patients who exceeded the Milan criteria had significantly higher AFP scores than those within the criteria (3.09 vs. 1.67; p=0.032). Patients experiencing early recurrence (within 12 months) were significantly younger (57 vs. 63 years; p=0.040).Conclusion: Preoperative AFP levels, along with increased tumor diameter and nodule count, are strong complementary predictors of postoperative HCC recurrence. In candidate selection and post-transplant risk stratification, incorporating biological markers, such as AFP, alongside morphological features is crucial, rather than relying solely on traditional static criteria.

Background/Objectives: The HALP score is a simple immunonutritional index calculated from routine preoperative hemoglobin, albumin, lymphocyte, and platelet values. We evaluated its association with mortality after liver transplantation for non-malignant indications and its prognostic contribution when considered with the Model for End-stage Liver Disease (MELD) score. Methods: We retrospectively analyzed 194 adults who underwent liver transplantation for non-malignant disease at a single center between January 2015 and January 2025. The primary outcome was all-cause post-transplant death. The cohort-derived HALP threshold was used for exploratory Kaplan–Meier and Cox analyses, while continuous HALP was examined in sensitivity analyses. Censoring-adjusted cumulative/dynamic ROC analyses evaluated discrimination at 30 days, 90 days, 1 year, and 3 years. Results: Over a median observed follow-up of 1108 days, 43 recipients (22.2%) died. Non-survivors had lower HALP values than survivors [0.52 (0.39–0.67) vs. 0.77 (0.54–1.04); p < 0.001]. HALP had the highest observed conventional AUC among the evaluated markers for overall mortality (AUC 0.735; 95% CI 0.657–0.814); pairwise AUC differences were not formally tested. The exploratory threshold was 0.6786. Mortality occurred in 36.3% of the low-HALP group and 9.7% of the high-HALP group. After adjustment for MELD and albumin, high versus low HALP remained associated with lower mortality (HR 0.239; 95% CI 0.116–0.493; p < 0.001). HALP also showed consistent time-dependent discrimination across the four evaluated horizons (AUC 0.713–0.738). Conclusions: Lower preoperative HALP was associated with higher post-transplant mortality in this non-malignant liver transplant cohort. HALP may provide complementary risk information, but the cohort-derived threshold requires independent external validation before clinical use.

Objective: To determine the rate of negative laparotomy in patients undergoing exploratory laparotomy for penetrating abdominal trauma during a period before routine computed tomography (CT)–based triage was integrated into the institutional pathway, and to compare clinical features and short-term outcomes between negative and therapeutic laparotomy groups.Methods: In total, 189 consecutive patients who underwent exploratory laparotomy for penetrating abdominal trauma between January 1997 and August 2002 were retrospectively reviewed. Patients were classified by operative findings as negative laparotomy (NL) or therapeutic laparotomy (TL); the NL group combined strictly negative explorations and non-therapeutic laparotomies with only incidental findings. Injury mechanism, wound characteristics, preoperative diagnostic approach, postoperative complications, in-hospital mortality and length of hospital stay were compared between groups.Results: NL occurred in 62/189 patients (32.8%; 95% CI 26.5–39.8) and TL in 127 (67.2%). Stab wounds accounted for 171 cases (90.5%) and gunshot wounds for 18 (9.5%). Mechanism, wound localization and wound number were not significantly associated with operative findings (p > 0.05). Local wound exploration alone was the most frequent diagnostic modality (131/189, 69.3%). Complications occurred in 1/62 NL (1.6%) and 8/127 TL (6.3%) patients (p = 0.276). All seven in-hospital deaths (3.7%) occurred in the TL group — five from exsanguinating vascular injury and two from late anastomotic leak. Median hospital stay was 5 days (IQR 4–6) in NL versus 7 days (IQR 6–9) in TL (p < 0.001).Conclusion: About one third of laparotomies in this pre-CT-triage cohort were negative. Injury descriptors and the preoperative diagnostic approach did not clearly discriminate NL from TL in this dataset; TL was associated with longer hospitalization. All deaths occurred in the TL group and reflected severe vascular or intestinal injury. These data provide a local baseline for evaluating outcomes after CT-supported selective management.