Title: Risk Factors Affecting the Incidence of CMV Infection in Recipients after Living Donor
Liver Transplantation
Version: 2 Date: 26 Mar 2025
Reviewer's report:
1. In a retrospective study, commenting on the incidence of CMV infection is inappropriate.
2. CMV viremia and CMV disease has been used interchangeably, however they both are
different. CMV Disease diagnosis requires histopathological diagnosis along with CMV
DNAmia.
3. All patients with viremia, whether or not they have CMV disease, were treated with
ganciclovir for three months or until two consecutive negative CMV PCRs. The treatment period
for three month is too long . What was the criteria to stop treatment after 3 months is not clear.
4.  Almost one third   of patient were on cyclosporine-based immunosuppression. was it due to
neurological complications in this group of patient.
5. The univariate regression analysis for potential risk factors for acquiring CMV infection
postoperatively revealed that a younger age of recipients was statistically significantly associated
with CMV infection, with a p-value of 0.016 and an odds ratio (OR) of 0.945 (0.902–0.989)
(95% CI). It appears that in the univariate analysis, younger age patients had lesser odds of
getting CMV infection. This significance was although lost on multivariate analysis, this point
has not been highlighted by the authors. It may be that in the presence of  cyclosporine based
immunosuppression, age doesn't matter.
6. Most prevalent risk factor for CMV infection was cyclosporine-based immunosuppression. It
is well known that degree of immunosuppression leads to reactivation of CMV posttransplant.
Given the high prevalence of postoperative infections others than CMV infection,  this might
point to the possibility of excessive immunosuppression in this group of patients.
7. There is a substantially significant relationship between CMV infection and positive CMV
IgM status of Donors. However, it would be interesting to know that how many of the
corresponding recipients had preoperative CMV IgM status positive. Also, whether, Donors
with positive preoperative CMV IgM , DNA PCR was performed or not.
Title: Risk Factors Affecting the Incidence of CMV Infection in Recipients after Living Donor
Liver Transplantation
Version: 2 Date: 26 Mar 2025
Reviewer's report:
1. In a retrospective study, commenting on the incidence of CMV infection is inappropriate.
2. CMV viremia and CMV disease has been used interchangeably, however they both are
different. CMV Disease diagnosis requires histopathological diagnosis along with CMV
DNAmia.
3. All patients with viremia, whether or not they have CMV disease, were treated with
ganciclovir for three months or until two consecutive negative CMV PCRs. The treatment period
for three month is too long . What was the criteria to stop treatment after 3 months is not clear.
4.  Almost one third   of patient were on cyclosporine-based immunosuppression. was it due to
neurological complications in this group of patient.
5. The univariate regression analysis for potential risk factors for acquiring CMV infection
postoperatively revealed that a younger age of recipients was statistically significantly associated
with CMV infection, with a p-value of 0.016 and an odds ratio (OR) of 0.945 (0.902–0.989)
(95% CI). It appears that in the univariate analysis, younger age patients had lesser odds of
getting CMV infection. This significance was although lost on multivariate analysis, this point
has not been highlighted by the authors. It may be that in the presence of  cyclosporine based
immunosuppression, age doesn't matter.
6. Most prevalent risk factor for CMV infection was cyclosporine-based immunosuppression. It
is well known that degree of immunosuppression leads to reactivation of CMV posttransplant.
Given the high prevalence of postoperative infections others than CMV infection,  this might
point to the possibility of excessive immunosuppression in this group of patients.
7. There is a substantially significant relationship between CMV infection and positive CMV
IgM status of Donors. However, it would be interesting to know that how many of the
corresponding recipients had preoperative CMV IgM status positive. Also, whether, Donors
with positive preoperative CMV IgM , DNA PCR was performed or not.
Please review this paper.
user
Title: Risk Factors Affecting the Incidence of CMV Infection in Recipients after Living Donor
Liver Transplantation
Version: 2 Date: 26 Mar 2025
Reviewer's report:
1. In a retrospective study, commenting on the incidence of CMV infection is inappropriate.
2. CMV viremia and CMV disease has been used interchangeably, however they both are
different. CMV Disease diagnosis requires histopathological diagnosis along with CMV
DNAmia.
3. All patients with viremia, whether or not they have CMV disease, were treated with
ganciclovir for three months or until two consecutive negative CMV PCRs. The treatment period
for three month is too long . What was the criteria to stop treatment after 3 months is not clear.
4.  Almost one third   of patient were on cyclosporine-based immunosuppression. was it due to
neurological complications in this group of patient.
5. The univariate regression analysis for potential risk factors for acquiring CMV infection
postoperatively revealed that a younger age of recipients was statistically significantly associated
with CMV infection, with a p-value of 0.016 and an odds ratio (OR) of 0.945 (0.902–0.989)
(95% CI). It appears that in the univariate analysis, younger age patients had lesser odds of
getting CMV infection. This significance was although lost on multivariate analysis, this point
has not been highlighted by the authors. It may be that in the presence of  cyclosporine based
immunosuppression, age doesn't matter.
6. Most prevalent risk factor for CMV infection was cyclosporine-based immunosuppression. It
is well known that degree of immunosuppression leads to reactivation of CMV posttransplant.
Given the high prevalence of postoperative infections others than CMV infection,  this might
point to the possibility of excessive immunosuppression in this group of patients.
7. There is a substantially significant relationship between CMV infection and positive CMV
IgM status of Donors. However, it would be interesting to know that how many of the
corresponding recipients had preoperative CMV IgM status positive. Also, whether, Donors
with positive preoperative CMV IgM , DNA PCR was performed or not.
assistant