Title: Impact of donor age on liver transplant outcomes in patients with hepatocellular
carcinoma: analysis of the SRTR database
Version: 2 Date: 22 Dec 2020
Reviewer's report:
In the current paper, the authors investigated the impact on donor age on OS and Recurrence
in a cohort of 13,276 patients with HCC who underwent liver transplantation. They found that
older donor age was associated with worse OS but no difference with respect to recurrence was
observed.
Main comments:
The paper lacks some novelty, as it has been previously shown that donor age correlates with
survival (the authors cite respective papers). In the current paper, the differences in OS with
respect to donor age were marginal in groups I-III, only those who received grafts from donors
older that 65 years (group IV) had a relevant drop in 5-year survival rate compared to the very
young donor group (group I). The p-value of <0.001 is highly significant but rather reflects the
large sample size (n=13,276) than clinically relevant differences. These needs to be highlighted
in the discussion. To further elaborate the impact of donor age on survival, it would be critical
to analyze the liver-related mortality in your cohort.
The discussion is way too long and needs to be shortened significantly. It should be sharper to
the point and less repetitive.
Minor:
In Table 1, the authors state Milan status. I assume Milan status was assessed prior to
transplantation (not at the time of listing) and downstaging was allowed. Similarly, I assume
tumor number and size only refer to viable tumor, correct? Where these varibales assessed by
radiology or pathology (explant histology)? Please specify.
Did patients with tumor recurrence have a shorter OS?
Patients who received downstaging before transplant had probably a higher tumor load and thus,
a higher risk of micrometastatic spread and HCC recurrence after transplant. Thus, pre-transplant
tumor therapy should also be included in the univariable analysis of OS.
Some typos should be corrected.
Title: Impact of donor age on liver transplant outcomes in patients with hepatocellular
carcinoma: analysis of the SRTR database
Version: 2 Date: 22 Dec 2020
Reviewer's report:
In the current paper, the authors investigated the impact on donor age on OS and Recurrence
in a cohort of 13,276 patients with HCC who underwent liver transplantation. They found that
older donor age was associated with worse OS but no difference with respect to recurrence was
observed.
Main comments:
The paper lacks some novelty, as it has been previously shown that donor age correlates with
survival (the authors cite respective papers). In the current paper, the differences in OS with
respect to donor age were marginal in groups I-III, only those who received grafts from donors
older that 65 years (group IV) had a relevant drop in 5-year survival rate compared to the very
young donor group (group I). The p-value of <0.001 is highly significant but rather reflects the
large sample size (n=13,276) than clinically relevant differences. These needs to be highlighted
in the discussion. To further elaborate the impact of donor age on survival, it would be critical
to analyze the liver-related mortality in your cohort.
The discussion is way too long and needs to be shortened significantly. It should be sharper to
the point and less repetitive.
Minor:
In Table 1, the authors state Milan status. I assume Milan status was assessed prior to
transplantation (not at the time of listing) and downstaging was allowed. Similarly, I assume
tumor number and size only refer to viable tumor, correct? Where these varibales assessed by
radiology or pathology (explant histology)? Please specify.
Did patients with tumor recurrence have a shorter OS?
Patients who received downstaging before transplant had probably a higher tumor load and thus,
a higher risk of micrometastatic spread and HCC recurrence after transplant. Thus, pre-transplant
tumor therapy should also be included in the univariable analysis of OS.
Some typos should be corrected.
Please review this paper.
user
Title: Impact of donor age on liver transplant outcomes in patients with hepatocellular
carcinoma: analysis of the SRTR database
Version: 2 Date: 22 Dec 2020
Reviewer's report:
In the current paper, the authors investigated the impact on donor age on OS and Recurrence
in a cohort of 13,276 patients with HCC who underwent liver transplantation. They found that
older donor age was associated with worse OS but no difference with respect to recurrence was
observed.
Main comments:
The paper lacks some novelty, as it has been previously shown that donor age correlates with
survival (the authors cite respective papers). In the current paper, the differences in OS with
respect to donor age were marginal in groups I-III, only those who received grafts from donors
older that 65 years (group IV) had a relevant drop in 5-year survival rate compared to the very
young donor group (group I). The p-value of <0.001 is highly significant but rather reflects the
large sample size (n=13,276) than clinically relevant differences. These needs to be highlighted
in the discussion. To further elaborate the impact of donor age on survival, it would be critical
to analyze the liver-related mortality in your cohort.
The discussion is way too long and needs to be shortened significantly. It should be sharper to
the point and less repetitive.
Minor:
In Table 1, the authors state Milan status. I assume Milan status was assessed prior to
transplantation (not at the time of listing) and downstaging was allowed. Similarly, I assume
tumor number and size only refer to viable tumor, correct? Where these varibales assessed by
radiology or pathology (explant histology)? Please specify.
Did patients with tumor recurrence have a shorter OS?
Patients who received downstaging before transplant had probably a higher tumor load and thus,
a higher risk of micrometastatic spread and HCC recurrence after transplant. Thus, pre-transplant
tumor therapy should also be included in the univariable analysis of OS.
Some typos should be corrected.
assistant