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The current liver allocation system may be disadvantaging younger adult recipients as it does not incorporate the donor-recipient age difference. Given the longer life expectancy of younger recipients, the influences of older donor grafts on their long-term prognosis should be elucidated. This study sought to reveal the long-term prognostic influence of the donor-recipient age difference in young adult recipients. Adult patients who received initial liver transplants from deceased donors between 2002 and 2021 were identified from the UNOS database. Young recipients (patients 45 years old or below) were categorized into 4 groups: donor age younger than the recipient, 0-9 years older, 10-19 years older, or 20 years older or above. Older recipients were defined as patients 65 years old or above.To examine the influence of the age difference in long-term survivors, conditional graft survival analysis was conducted on both younger and older recipients.Among 91,952 transplant recipients, 15,170 patients were 45 years old or below (16.5%); these were categorized into 6,114 (40.3%), 3,315 (21.9%), 2,970 (19.6%), and 2,771 (18.3%) for groups 1-4, respectively. Group 1 demonstrated the highest probability of survival, followed by groups 2, 3, and 4 for the actual graft survival and conditional graft survival analyses. In younger recipients who survived at least 5 years post-transplant, inferior long-term survival was observed when there was an age difference of 10 years or above (86.9% vs. 80.6%, logrank p < 0.01), whereas there was no difference in older recipients (72.6% vs. 74.2%, log-rank p = 0.89). In younger patients who are not in emergent need of a transplant, preferential allocation of younger aged donor offers would optimize organ utility by increasing postoperative graft survival time.

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Background: Various nutritional/inflammatory scores reportedly correlate with surgical outcomes of abdominal surgery, while it remains inconclusive which one is the best in prediction of short-term surgical outcomes of patients with colorectal liver metastasis (CLM). Methods: Clinical records of 367 hepatectomies for 267 patients with CLM were retrospectively reviewed. Preoperative nutritional/inflammatory status was determined using 14 reported nutritional/inflammatory scores and predictive powers of these scores for short-term surgical outcomes were compared. Results: In receiver operating characteristics curve analysis, controlling nutritional status (CONUT) score showed the highest performance in prediction of major postoperative morbidity (area under the curve [AUC], 0.650) among the tested scores and similar tendency was also confirmed in prediction of global postoperative morbidity (AUC, 0.622). Multivariate analysis confirmed that the CONUT score showed significant correlation with both global morbidity (odds ratio [OR], 1.29; 95% CI, 1.11-1.49, P=0.001) and major morbidity (OR, 1.31; 95% CI, 1.08-1.60; P=0.006). When preoperative degree of malnutrition was classified into normal, light, and moderate according to the original CONUT scoring system, short-term surgical outcomes were well stratified as follows: any morbidity, 21.8% vs. 35.1% vs. 51.9% (P=0.001); major morbidity, 6.2% vs. 11.7% vs. 29.6% (P=0.002); and postoperative hospital stay, 11 days vs. 11 days vs. 12 days (P=0.006). Conclusions: The CONUT score could be a simple and reliable predictor of short-term surgical outcomes of patients undergoing hepatectomy for CLM.

Background: Given the scarce evidence regarding the impact of preoperative nutritional status on surgical outcomes of patients with hepatocellular carcinoma, predictive powers of nutritional/inflammatory scores for short-term surgical outcomes in patients with hepatocellular carcinoma were investigated. Methods: Outcomes of 1272 patients with hepatocellular carcinoma were reviewed, and predictive powers of nine nutritional/inflammatory scores for short-term surgical outcomes were compared using the receiver-operating characteristic curve analysis. Clinical relevance of the best nutritional score was then studied in detail to clarify its utility as an alternative predictive measure for surgical risk of patients with hepatocellular carcinoma. Results: Receiver-operating characteristic curve analysis showed the controlling nutritional status score has the best performance in prediction of morbidity after hepatectomy for hepatocellular carcinoma (area under the curve, 0.593; 95% confidence interval: 0.552–0.635; p < 0.001), and multivariate analysis confirmed its correlation with the risk of any morbidity (odds ratio per +1 point, 1.17; 95% confidence interval: 1.08–1.27; p < 0.001) and major morbidity (odds ratio per +1 point, 1.14; 95% confidence interval: 0.99–1.27; p = 0.052). The undernutrition grade based on the controlling nutritional status score showed strong correlation with the degree of fibrosis in the liver ( p < 0.001), platelet count ( p < 0.001), and indocyanine green retention rate at 15 min ( p < 0.001). In addition, the controlling nutritional status undernutrition grade well stratified the risk of postoperative morbidity especially in cirrhotic subpopulation (odds ratio, 1.17 per +1 point; 95% confidence interval: 1.05–1.29 for any morbidity and odds ratio, 1.20 per +1 point; 95% confidence interval: 1.03–1.40 for major morbidity). Conclusion: The controlling nutritional status score could be an alternative measure for underlying liver injury and the surgical risk of hepatocellular carcinoma.