Title: Clinical significance of transjugular liver biopsy in acute liver failure – a real-world
analysis
Version: 4 Date: 30 May 2024
Reviewer's report:
Thank you for your submission.
You provide data on the role of TJLB in patients with ALF but importantly its role it affecting
therapeutic management .
Overall, I think this is a well written paper. It provides critical evaluation of the role of TJLB.
It provides evidence that the procedure is safe but does not change clinical management and is
potentially high risk given the biochemical and physiological changes present in patients with
ALF.
Minor
1. Results  Impact of histo results:
- You list 5 patients that were initially catergorised as cryptogenic, of which a definitive
diagnosis was found.  Can you list what the 3 cases were? I appreciate its listed in Table 2 but
its worth highlighting it in the text.
2. It may be worth mentioning that in patients with sickle cell disease, assessment of sickle
fraction and exchange transfusions to reduce the fraction irrespective of a liver biopsy.
Title: Clinical significance of transjugular liver biopsy in acute liver failure – a real-world
analysis
Version: 4 Date: 30 May 2024
Reviewer's report:
Thank you for your submission.
You provide data on the role of TJLB in patients with ALF but importantly its role it affecting
therapeutic management .
Overall, I think this is a well written paper. It provides critical evaluation of the role of TJLB.
It provides evidence that the procedure is safe but does not change clinical management and is
potentially high risk given the biochemical and physiological changes present in patients with
ALF.
Minor
1. Results  Impact of histo results:
- You list 5 patients that were initially catergorised as cryptogenic, of which a definitive
diagnosis was found.  Can you list what the 3 cases were? I appreciate its listed in Table 2 but
its worth highlighting it in the text.
2. It may be worth mentioning that in patients with sickle cell disease, assessment of sickle
fraction and exchange transfusions to reduce the fraction irrespective of a liver biopsy.
Please review this paper.
user
Title: Clinical significance of transjugular liver biopsy in acute liver failure – a real-world
analysis
Version: 4 Date: 30 May 2024
Reviewer's report:
Thank you for your submission.
You provide data on the role of TJLB in patients with ALF but importantly its role it affecting
therapeutic management .
Overall, I think this is a well written paper. It provides critical evaluation of the role of TJLB.
It provides evidence that the procedure is safe but does not change clinical management and is
potentially high risk given the biochemical and physiological changes present in patients with
ALF.
Minor
1. Results  Impact of histo results:
- You list 5 patients that were initially catergorised as cryptogenic, of which a definitive
diagnosis was found.  Can you list what the 3 cases were? I appreciate its listed in Table 2 but
its worth highlighting it in the text.
2. It may be worth mentioning that in patients with sickle cell disease, assessment of sickle
fraction and exchange transfusions to reduce the fraction irrespective of a liver biopsy.
assistant