Title: BODY COMPOSITION AND MUSCLE COMPOSITION PHENOTYPES IN
PATIENTS ON WAITLIST AND SHORTLY AFTER LIVER TRANSPLANT – RESULTS
FROM A PILOT STUDY
Version: 0 Date: 18 May 2024
Reviewer's report:
Forsgren and co-authors report a pilot study of pre- and post-liver transplant body composition
using MRI based analysis in a small single-center patient cohort. I congratulate them on a
clearly written report that will guide design and execution of a potentially practice-changing
investigation of body composition in liver transplantation.
I suggest that the authors consider discussing several issues in the design of their upcoming work:
Can a multi-center vs a single-center design provide enhanced impact and generalizability?
MASLD is becoming a dominant cause of ESLD requiring transplantation. Its components have
predictable impacts on immediate and prolonged muscle, fat, and functional outcomes that set it
apart from other diseases.  I would consider whether limiting the study population to MASLD or
else expanding it to allow a valid subanalysis of the MASLD subpopulation would have merit.
This research team has an opportunity to connect the dots among key outcomes domains that
are usually ignored in overfocused prospective studies.
There should be objective longitudinal measurement of functional physical activity status and
outcomes pre- and post-transplant.  I would give each subject a wearable personal activity
monitor and include steps/day as a tracked baseline parameter and post transplant outcome that
is likely to be superior to LFI or other measurements.
Consider tracking post transplant morbidity (hospital days, actual cost of care) as a key outcome.
Use a standardized QOL metric as a tracked outcome.
Title: BODY COMPOSITION AND MUSCLE COMPOSITION PHENOTYPES IN
PATIENTS ON WAITLIST AND SHORTLY AFTER LIVER TRANSPLANT – RESULTS
FROM A PILOT STUDY
Version: 0 Date: 18 May 2024
Reviewer's report:
Forsgren and co-authors report a pilot study of pre- and post-liver transplant body composition
using MRI based analysis in a small single-center patient cohort. I congratulate them on a
clearly written report that will guide design and execution of a potentially practice-changing
investigation of body composition in liver transplantation.
I suggest that the authors consider discussing several issues in the design of their upcoming work:
Can a multi-center vs a single-center design provide enhanced impact and generalizability?
MASLD is becoming a dominant cause of ESLD requiring transplantation. Its components have
predictable impacts on immediate and prolonged muscle, fat, and functional outcomes that set it
apart from other diseases.  I would consider whether limiting the study population to MASLD or
else expanding it to allow a valid subanalysis of the MASLD subpopulation would have merit.
This research team has an opportunity to connect the dots among key outcomes domains that
are usually ignored in overfocused prospective studies.
There should be objective longitudinal measurement of functional physical activity status and
outcomes pre- and post-transplant.  I would give each subject a wearable personal activity
monitor and include steps/day as a tracked baseline parameter and post transplant outcome that
is likely to be superior to LFI or other measurements.
Consider tracking post transplant morbidity (hospital days, actual cost of care) as a key outcome.
Use a standardized QOL metric as a tracked outcome.
Please review this paper.
user
Title: BODY COMPOSITION AND MUSCLE COMPOSITION PHENOTYPES IN
PATIENTS ON WAITLIST AND SHORTLY AFTER LIVER TRANSPLANT – RESULTS
FROM A PILOT STUDY
Version: 0 Date: 18 May 2024
Reviewer's report:
Forsgren and co-authors report a pilot study of pre- and post-liver transplant body composition
using MRI based analysis in a small single-center patient cohort. I congratulate them on a
clearly written report that will guide design and execution of a potentially practice-changing
investigation of body composition in liver transplantation.
I suggest that the authors consider discussing several issues in the design of their upcoming work:
Can a multi-center vs a single-center design provide enhanced impact and generalizability?
MASLD is becoming a dominant cause of ESLD requiring transplantation. Its components have
predictable impacts on immediate and prolonged muscle, fat, and functional outcomes that set it
apart from other diseases.  I would consider whether limiting the study population to MASLD or
else expanding it to allow a valid subanalysis of the MASLD subpopulation would have merit.
This research team has an opportunity to connect the dots among key outcomes domains that
are usually ignored in overfocused prospective studies.
There should be objective longitudinal measurement of functional physical activity status and
outcomes pre- and post-transplant.  I would give each subject a wearable personal activity
monitor and include steps/day as a tracked baseline parameter and post transplant outcome that
is likely to be superior to LFI or other measurements.
Consider tracking post transplant morbidity (hospital days, actual cost of care) as a key outcome.
Use a standardized QOL metric as a tracked outcome.
assistant