Reviewer ’s report  
 
Title: Sofosbuvir add -on to ribavirin for chronic hepatitis E in a cirrhotic liver transplant 
recipient: a case report  
 
Version: 0 Date: 12 Apr 2019  
 
Reviewer: Kuan -Chih Chen  
 
Reviewer's report:  
 
Montserrat Fraga et al. highlighted an important issue about increasing bur den of chronic 
hepatitis E (CHE) in the era of organ transplantation, and demonstrated a case using combination 
therapy of ribavirin and sofosbuvir(SOF) for treating CHE in a patient with history of liver 
transplantation. Although the treatment result was convincing, and the writing was constructive, 
and there are still some questions raised.  
1. Did your institutional review board approve the usage of SOF in this patient because of the 
concern about off -label use?  
 
2. On page 4 line 45, how did you get a sto red serum sample which was obtained several years 
ago, did you routinely store serum sample for the patients who received organ 
transplantation?  
 
3. What's the novelty of this case report? Because you mentioned that there were already six 
cases report regar ding the use of SOF in chronic hepatitis E, what's the difference between 
this one from others?  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your  comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
  
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statisti cal review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in th e manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation  that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to al l of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree to the open peer review policy of the journal. I understand that my na me will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made availab le under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will n ot be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Sofosbuvir add -on to ribavirin for chronic hepatitis E in a cirrhotic liver transplant 
recipient: a case report  
 
Version: 0 Date: 12 Apr 2019  
 
Reviewer: Kuan -Chih Chen  
 
Reviewer's report:  
 
Montserrat Fraga et al. highlighted an important issue about increasing bur den of chronic 
hepatitis E (CHE) in the era of organ transplantation, and demonstrated a case using combination 
therapy of ribavirin and sofosbuvir(SOF) for treating CHE in a patient with history of liver 
transplantation. Although the treatment result was convincing, and the writing was constructive, 
and there are still some questions raised.  
1. Did your institutional review board approve the usage of SOF in this patient because of the 
concern about off -label use?  
 
2. On page 4 line 45, how did you get a sto red serum sample which was obtained several years 
ago, did you routinely store serum sample for the patients who received organ 
transplantation?  
 
3. What's the novelty of this case report? Because you mentioned that there were already six 
cases report regar ding the use of SOF in chronic hepatitis E, what's the difference between 
this one from others?  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your  comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
  
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statisti cal review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in th e manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation  that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to al l of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree to the open peer review policy of the journal. I understand that my na me will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made availab le under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will n ot be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Sofosbuvir add -on to ribavirin for chronic hepatitis E in a cirrhotic liver transplant 
recipient: a case report  
 
Version: 0 Date: 12 Apr 2019  
 
Reviewer: Kuan -Chih Chen  
 
Reviewer's report:  
 
Montserrat Fraga et al. highlighted an important issue about increasing bur den of chronic 
hepatitis E (CHE) in the era of organ transplantation, and demonstrated a case using combination 
therapy of ribavirin and sofosbuvir(SOF) for treating CHE in a patient with history of liver 
transplantation. Although the treatment result was convincing, and the writing was constructive, 
and there are still some questions raised.  
1. Did your institutional review board approve the usage of SOF in this patient because of the 
concern about off -label use?  
 
2. On page 4 line 45, how did you get a sto red serum sample which was obtained several years 
ago, did you routinely store serum sample for the patients who received organ 
transplantation?  
 
3. What's the novelty of this case report? Because you mentioned that there were already six 
cases report regar ding the use of SOF in chronic hepatitis E, what's the difference between 
this one from others?  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your  comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
  
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statisti cal review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in th e manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation  that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to al l of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree to the open peer review policy of the journal. I understand that my na me will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made availab le under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will n ot be published.  
 
I agree to the open peer review policy of the journal  
assistant