Reviewer’s report
Title: 
Salvage Liver Transplantation After Resection of Colorectal Cancer Liver
Metastasis With Favorable Outcomes; A Case Report And Review of literature
Version: 
0 
Date: 
24 Nov 2020
Reviewer's report:
The Authors describe the case of a patient with post-operative liver failure
(POLF) after right hepatectomy for CRLMs, salvaged with liver transplantation.
I have several reservations regarding the description and the management of the
patient:
- The Authors should detail the reason for opting for a Rt hepatectomy.
Otherwise my impression is that the metastatic lesions are of limited size and
could probably be treated with a more limited resection rather than with a right
hepatectomy (also the position of the lesions, looking at the few PET-CT images,
seem to allow a parenchyma sparing approach); especially in such a young
patient, the need to preserve as much parechyma as possible is pivotal in view of
expected further resection, due to the natural history of the disease; as an
example, is there any CT scan image that show the main met being in contact
wih the right portal branch?
- in the context of 12 cycles history of chemo, did the Authors assess the
background liver function with any test preoperatively (e.g. ICG-RR15, LiMAx,
or similar)? Did they consider inducing hypertrophy in the future liver remnant
(e.g. PVL, PVE, ALPPS, or alternatives)? These should be commented in the
text;
- the background liver in the specimen was normal, therefore unlikely to develop
POLF if more than 50% of parenchyma was preserved, as the Authors stated;
were there any vascular or other type of complications in the liver that could
justify the acute liver failure? What is the impression of the authors regarding the
cause of the POLF? When did POLF develop (post-op day)? 
- Did the Authors have more detailed information about the histology of the
primary tumor (mutations, MSI, KRAS, BRAF) that could aid the decision to
proceed to salvage transplantation with acceptable risk of futility? 
- What type of OLT was performed (deceased, living, DBD, DCD)? It'd be
useful to provide the reader with some background regarding OLT in Saudi
Arabia and what are the local policies so that the decision to offer OLT is framed
in context. 
Minor comments: 
- English native speaker editing is required. Some capital letters are used
liberally.
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registered for such service or help editors to identify candidate reviewers. Please
find the details of processing in Publons’ privacy policy
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Yes
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 all 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
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
No
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Reviewer’s report
Title: 
Salvage Liver Transplantation After Resection of Colorectal Cancer Liver
Metastasis With Favorable Outcomes; A Case Report And Review of literature
Version: 
0 
Date: 
24 Nov 2020
Reviewer's report:
The Authors describe the case of a patient with post-operative liver failure
(POLF) after right hepatectomy for CRLMs, salvaged with liver transplantation.
I have several reservations regarding the description and the management of the
patient:
- The Authors should detail the reason for opting for a Rt hepatectomy.
Otherwise my impression is that the metastatic lesions are of limited size and
could probably be treated with a more limited resection rather than with a right
hepatectomy (also the position of the lesions, looking at the few PET-CT images,
seem to allow a parenchyma sparing approach); especially in such a young
patient, the need to preserve as much parechyma as possible is pivotal in view of
expected further resection, due to the natural history of the disease; as an
example, is there any CT scan image that show the main met being in contact
wih the right portal branch?
- in the context of 12 cycles history of chemo, did the Authors assess the
background liver function with any test preoperatively (e.g. ICG-RR15, LiMAx,
or similar)? Did they consider inducing hypertrophy in the future liver remnant
(e.g. PVL, PVE, ALPPS, or alternatives)? These should be commented in the
text;
- the background liver in the specimen was normal, therefore unlikely to develop
POLF if more than 50% of parenchyma was preserved, as the Authors stated;
were there any vascular or other type of complications in the liver that could
justify the acute liver failure? What is the impression of the authors regarding the
cause of the POLF? When did POLF develop (post-op day)? 
- Did the Authors have more detailed information about the histology of the
primary tumor (mutations, MSI, KRAS, BRAF) that could aid the decision to
proceed to salvage transplantation with acceptable risk of futility? 
- What type of OLT was performed (deceased, living, DBD, DCD)? It'd be
useful to provide the reader with some background regarding OLT in Saudi
Arabia and what are the local policies so that the decision to offer OLT is framed
in context. 
Minor comments: 
- English native speaker editing is required. Some capital letters are used
liberally.
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons after the final decision on the manuscript has been made. If you have
already registered at Publons, they will notify you of the receipt of this review
and update your profile 
as per your settings and their policy. If you are not
registered with Publons, you will receive an email from them asking you to
register in order for them to be able to recognize your review on your new
profile page. Publons may use the Review Data to generate derivative metadata
for the benefit of Publons and you as a reviewer, carefully considering the
sensitivity of such information. For example, Publons may verify your record as
a reviewer by updating your profile published on its webservice if you have
registered for such service or help editors to identify candidate reviewers. Please
find the details of processing in Publons’ privacy policy
https://publons.com/about/terms
Yes
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 all 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
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
No
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Please review this paper.
user
Reviewer’s report
Title: 
Salvage Liver Transplantation After Resection of Colorectal Cancer Liver
Metastasis With Favorable Outcomes; A Case Report And Review of literature
Version: 
0 
Date: 
24 Nov 2020
Reviewer's report:
The Authors describe the case of a patient with post-operative liver failure
(POLF) after right hepatectomy for CRLMs, salvaged with liver transplantation.
I have several reservations regarding the description and the management of the
patient:
- The Authors should detail the reason for opting for a Rt hepatectomy.
Otherwise my impression is that the metastatic lesions are of limited size and
could probably be treated with a more limited resection rather than with a right
hepatectomy (also the position of the lesions, looking at the few PET-CT images,
seem to allow a parenchyma sparing approach); especially in such a young
patient, the need to preserve as much parechyma as possible is pivotal in view of
expected further resection, due to the natural history of the disease; as an
example, is there any CT scan image that show the main met being in contact
wih the right portal branch?
- in the context of 12 cycles history of chemo, did the Authors assess the
background liver function with any test preoperatively (e.g. ICG-RR15, LiMAx,
or similar)? Did they consider inducing hypertrophy in the future liver remnant
(e.g. PVL, PVE, ALPPS, or alternatives)? These should be commented in the
text;
- the background liver in the specimen was normal, therefore unlikely to develop
POLF if more than 50% of parenchyma was preserved, as the Authors stated;
were there any vascular or other type of complications in the liver that could
justify the acute liver failure? What is the impression of the authors regarding the
cause of the POLF? When did POLF develop (post-op day)? 
- Did the Authors have more detailed information about the histology of the
primary tumor (mutations, MSI, KRAS, BRAF) that could aid the decision to
proceed to salvage transplantation with acceptable risk of futility? 
- What type of OLT was performed (deceased, living, DBD, DCD)? It'd be
useful to provide the reader with some background regarding OLT in Saudi
Arabia and what are the local policies so that the decision to offer OLT is framed
in context. 
Minor comments: 
- English native speaker editing is required. Some capital letters are used
liberally.
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons after the final decision on the manuscript has been made. If you have
already registered at Publons, they will notify you of the receipt of this review
and update your profile 
as per your settings and their policy. If you are not
registered with Publons, you will receive an email from them asking you to
register in order for them to be able to recognize your review on your new
profile page. Publons may use the Review Data to generate derivative metadata
for the benefit of Publons and you as a reviewer, carefully considering the
sensitivity of such information. For example, Publons may verify your record as
a reviewer by updating your profile published on its webservice if you have
registered for such service or help editors to identify candidate reviewers. Please
find the details of processing in Publons’ privacy policy
https://publons.com/about/terms
Yes
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 all 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
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
No
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
assistant