Reviewer's report
Title:Excessive Intraoperative Blood Loss Independently Predicts Recurrence of
Hepatocellular Carcinoma after Liver Transplantation
Version:2Date:13 June 2015
Reviewer: Matteo Ravaioli
Reviewer's report:
The paper by Liu et al reported an important series of liver transplantation for
HCC and they found a relevant prognostic role of blood loss. Patients with more
than 4 L of blood loss had a significant risk of tumor recurrence at the univariate
and multivariate analysis.
The results after liver transplantation are very poor with a high rate of HCC
recurrence (43%), which is not comparable to the other series reported. I would
suggest to perform a further analysis with the patients witout macrovascular
invasion and meeting the Milan criteria to evaluate the rate of HCC recurrence
and to confirm a prognostic role of blood loss. I believe that a minimum follow-up
of one year is necessary so I would exclude the cases with a follow-up less than
1 year.
I could not understand among the 479 cases how many were excluded because
of death within 30 days post-op. and if these cases were computed in the survival
analysis.
The other main problem to understand is the blood transfusion, which should
have a liner correlation with the blood loss. I cannot understand why the blood
loss had a prognostic role for HCC recurrence and this role was not present for
the blood loss.
I cannot find how many patients were transplanted with use of the by-pass.
The other important aspect is the pre-operative treatment over a ten years of
experience. How many patients had liver resection before? Which were the down
staging procedures for patients out of the Milan criteria? Further data are
necessary to understand the center policy, which should be adapted to reduce
the high rate of tumor recurrence after liver transplantation to a conventional rate
of 10%.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests
Reviewer's report
Title:Excessive Intraoperative Blood Loss Independently Predicts Recurrence of
Hepatocellular Carcinoma after Liver Transplantation
Version:2Date:13 June 2015
Reviewer: Matteo Ravaioli
Reviewer's report:
The paper by Liu et al reported an important series of liver transplantation for
HCC and they found a relevant prognostic role of blood loss. Patients with more
than 4 L of blood loss had a significant risk of tumor recurrence at the univariate
and multivariate analysis.
The results after liver transplantation are very poor with a high rate of HCC
recurrence (43%), which is not comparable to the other series reported. I would
suggest to perform a further analysis with the patients witout macrovascular
invasion and meeting the Milan criteria to evaluate the rate of HCC recurrence
and to confirm a prognostic role of blood loss. I believe that a minimum follow-up
of one year is necessary so I would exclude the cases with a follow-up less than
1 year.
I could not understand among the 479 cases how many were excluded because
of death within 30 days post-op. and if these cases were computed in the survival
analysis.
The other main problem to understand is the blood transfusion, which should
have a liner correlation with the blood loss. I cannot understand why the blood
loss had a prognostic role for HCC recurrence and this role was not present for
the blood loss.
I cannot find how many patients were transplanted with use of the by-pass.
The other important aspect is the pre-operative treatment over a ten years of
experience. How many patients had liver resection before? Which were the down
staging procedures for patients out of the Milan criteria? Further data are
necessary to understand the center policy, which should be adapted to reduce
the high rate of tumor recurrence after liver transplantation to a conventional rate
of 10%.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests
Please review this paper.
user
Reviewer's report
Title:Excessive Intraoperative Blood Loss Independently Predicts Recurrence of
Hepatocellular Carcinoma after Liver Transplantation
Version:2Date:13 June 2015
Reviewer: Matteo Ravaioli
Reviewer's report:
The paper by Liu et al reported an important series of liver transplantation for
HCC and they found a relevant prognostic role of blood loss. Patients with more
than 4 L of blood loss had a significant risk of tumor recurrence at the univariate
and multivariate analysis.
The results after liver transplantation are very poor with a high rate of HCC
recurrence (43%), which is not comparable to the other series reported. I would
suggest to perform a further analysis with the patients witout macrovascular
invasion and meeting the Milan criteria to evaluate the rate of HCC recurrence
and to confirm a prognostic role of blood loss. I believe that a minimum follow-up
of one year is necessary so I would exclude the cases with a follow-up less than
1 year.
I could not understand among the 479 cases how many were excluded because
of death within 30 days post-op. and if these cases were computed in the survival
analysis.
The other main problem to understand is the blood transfusion, which should
have a liner correlation with the blood loss. I cannot understand why the blood
loss had a prognostic role for HCC recurrence and this role was not present for
the blood loss.
I cannot find how many patients were transplanted with use of the by-pass.
The other important aspect is the pre-operative treatment over a ten years of
experience. How many patients had liver resection before? Which were the down
staging procedures for patients out of the Milan criteria? Further data are
necessary to understand the center policy, which should be adapted to reduce
the high rate of tumor recurrence after liver transplantation to a conventional rate
of 10%.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests
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