Title: Angiotensin Receptor Blockers Might be Protective against Hepatic Steatosis after Liver
Transplantation
Version: 2 Date: 27 Nov 2022
Reviewer's report:
This work provided novel clinical data regarding the effect of ARBs in the development of
NAFLD in liver transplant recipients. The study type chosen (case-control) as well as the
assessment of steatosis via ultrasounds were plausible methods to answer the research question.
The team had a reasonable sample size (N = >30) of liver transplant recipients from a single
center and had access to blood profiles for the patients who were followed in the outpatient clinic.
A major limitation of this study was the lack of health parameter information (BMI, past medical
history, pre transplant biopsy, lipid panel) of the liver donors, as well as the year in which the
team started following up the transplant patients (only end date was noted). The study would
also be bolstered if there were data regarding the level of compliance (consistency, doses missed,
etc.) in ARB therapy in the outpatient clinic.
It would be interesting to test the effect of each ARB and not the entire class. In this study
valsartan was group together with losartan despite these two having different half-lives in the
body.
The investigators should also explore the effect of ACE inhibitors and the incidence rate of
NAFLD since these types of drugs act on the same cascade as ARBs.
Figures 1 and 2 were missing a y-axis label, these should be added for further clarity.
Table 2 suggests that exposure to ARBs renders patients almost three times more likely to
develop NAFLD, flipping the odds-ratio values is suggested for more clarity and consistency
with the rest of the paper.
Title: Angiotensin Receptor Blockers Might be Protective against Hepatic Steatosis after Liver
Transplantation
Version: 2 Date: 27 Nov 2022
Reviewer's report:
This work provided novel clinical data regarding the effect of ARBs in the development of
NAFLD in liver transplant recipients. The study type chosen (case-control) as well as the
assessment of steatosis via ultrasounds were plausible methods to answer the research question.
The team had a reasonable sample size (N = >30) of liver transplant recipients from a single
center and had access to blood profiles for the patients who were followed in the outpatient clinic.
A major limitation of this study was the lack of health parameter information (BMI, past medical
history, pre transplant biopsy, lipid panel) of the liver donors, as well as the year in which the
team started following up the transplant patients (only end date was noted). The study would
also be bolstered if there were data regarding the level of compliance (consistency, doses missed,
etc.) in ARB therapy in the outpatient clinic.
It would be interesting to test the effect of each ARB and not the entire class. In this study
valsartan was group together with losartan despite these two having different half-lives in the
body.
The investigators should also explore the effect of ACE inhibitors and the incidence rate of
NAFLD since these types of drugs act on the same cascade as ARBs.
Figures 1 and 2 were missing a y-axis label, these should be added for further clarity.
Table 2 suggests that exposure to ARBs renders patients almost three times more likely to
develop NAFLD, flipping the odds-ratio values is suggested for more clarity and consistency
with the rest of the paper.
Please review this paper.
user
Title: Angiotensin Receptor Blockers Might be Protective against Hepatic Steatosis after Liver
Transplantation
Version: 2 Date: 27 Nov 2022
Reviewer's report:
This work provided novel clinical data regarding the effect of ARBs in the development of
NAFLD in liver transplant recipients. The study type chosen (case-control) as well as the
assessment of steatosis via ultrasounds were plausible methods to answer the research question.
The team had a reasonable sample size (N = >30) of liver transplant recipients from a single
center and had access to blood profiles for the patients who were followed in the outpatient clinic.
A major limitation of this study was the lack of health parameter information (BMI, past medical
history, pre transplant biopsy, lipid panel) of the liver donors, as well as the year in which the
team started following up the transplant patients (only end date was noted). The study would
also be bolstered if there were data regarding the level of compliance (consistency, doses missed,
etc.) in ARB therapy in the outpatient clinic.
It would be interesting to test the effect of each ARB and not the entire class. In this study
valsartan was group together with losartan despite these two having different half-lives in the
body.
The investigators should also explore the effect of ACE inhibitors and the incidence rate of
NAFLD since these types of drugs act on the same cascade as ARBs.
Figures 1 and 2 were missing a y-axis label, these should be added for further clarity.
Table 2 suggests that exposure to ARBs renders patients almost three times more likely to
develop NAFLD, flipping the odds-ratio values is suggested for more clarity and consistency
with the rest of the paper.
assistant