Reviewer’s report
Title: 
Incidentalomas Are Associated with an Increase in Liver Transplantation
in Patients with Cirrhosis: A Single-Center Retrospective Study
Version: 
0 
Date: 
01 May 2022
Reviewer: 
Konstantina Kyritsi
Reviewer's report:
In this manuscript the authors study the role of incidentalomas, that are defined
as incidental findings of imaging, on liver transplantation. For their studies the
authors gather the data from 720 patients affected by NASH, HCV and alcohol,
liver disease, that underwent in surgery and performed survival analysis utilizing
Kaplan Meier and Cox proportional hazards regression analysis to determine
factors that are associated with liver transplantation. They shown that
incidentaloma was associated with a 30% increase in the risk of liver
transplantation. Patients with cirrhosis from alcohol or HCV had a significantly
shorter median time to transplantation than patients with NASH and
incidentalomas are common in patients affected by cirrhosis.
Please address the following points for proceed with this paper publication:
1. In their work the authors discover that of 690 extrahepatic lesions were found
amongst 720 patients, approximately 80% of patients had an incidentaloma
discovered, and 106 patients (18.5%) had more than one extrahepatic
incidentaloma. Could the authors speculate about the reason by which the
extrahepatic lesions are so high incidence compared to intrahepatic?
2. In the tables that are gathered the characteristics of the patients present
incidentalomas we observe that there is a high percentage of male. It does mean
that these findings regard more the male than the female? Please, clarify this
point.
3. In the table 4, where the authors shown the univariate Cox proportional
hazards regression analysis for predicting liver transplantation there are different
groups; White, African American, Asian Hispanic/Latino, Other Race. In the
table 5, that multivariate Cox proportional hazards regression analysis for
predicting liver transplantation the authors shown only two of the above race,
white and Hispano/Latino. It should be interesting if they add also the other
groups.
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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.
No
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
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I agree to the terms of the CC-BY 4.0 license; please publish my name with my
report.
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?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Reviewer’s report
Title: 
Incidentalomas Are Associated with an Increase in Liver Transplantation
in Patients with Cirrhosis: A Single-Center Retrospective Study
Version: 
0 
Date: 
01 May 2022
Reviewer: 
Konstantina Kyritsi
Reviewer's report:
In this manuscript the authors study the role of incidentalomas, that are defined
as incidental findings of imaging, on liver transplantation. For their studies the
authors gather the data from 720 patients affected by NASH, HCV and alcohol,
liver disease, that underwent in surgery and performed survival analysis utilizing
Kaplan Meier and Cox proportional hazards regression analysis to determine
factors that are associated with liver transplantation. They shown that
incidentaloma was associated with a 30% increase in the risk of liver
transplantation. Patients with cirrhosis from alcohol or HCV had a significantly
shorter median time to transplantation than patients with NASH and
incidentalomas are common in patients affected by cirrhosis.
Please address the following points for proceed with this paper publication:
1. In their work the authors discover that of 690 extrahepatic lesions were found
amongst 720 patients, approximately 80% of patients had an incidentaloma
discovered, and 106 patients (18.5%) had more than one extrahepatic
incidentaloma. Could the authors speculate about the reason by which the
extrahepatic lesions are so high incidence compared to intrahepatic?
2. In the tables that are gathered the characteristics of the patients present
incidentalomas we observe that there is a high percentage of male. It does mean
that these findings regard more the male than the female? Please, clarify this
point.
3. In the table 4, where the authors shown the univariate Cox proportional
hazards regression analysis for predicting liver transplantation there are different
groups; White, African American, Asian Hispanic/Latino, Other Race. In the
table 5, that multivariate Cox proportional hazards regression analysis for
predicting liver transplantation the authors shown only two of the above race,
white and Hispano/Latino. It should be interesting if they add also the other
groups.
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.
No
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 publish my name with my
report.
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?
Yes
Is the presentation of the work clear?
Yes
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: 
Incidentalomas Are Associated with an Increase in Liver Transplantation
in Patients with Cirrhosis: A Single-Center Retrospective Study
Version: 
0 
Date: 
01 May 2022
Reviewer: 
Konstantina Kyritsi
Reviewer's report:
In this manuscript the authors study the role of incidentalomas, that are defined
as incidental findings of imaging, on liver transplantation. For their studies the
authors gather the data from 720 patients affected by NASH, HCV and alcohol,
liver disease, that underwent in surgery and performed survival analysis utilizing
Kaplan Meier and Cox proportional hazards regression analysis to determine
factors that are associated with liver transplantation. They shown that
incidentaloma was associated with a 30% increase in the risk of liver
transplantation. Patients with cirrhosis from alcohol or HCV had a significantly
shorter median time to transplantation than patients with NASH and
incidentalomas are common in patients affected by cirrhosis.
Please address the following points for proceed with this paper publication:
1. In their work the authors discover that of 690 extrahepatic lesions were found
amongst 720 patients, approximately 80% of patients had an incidentaloma
discovered, and 106 patients (18.5%) had more than one extrahepatic
incidentaloma. Could the authors speculate about the reason by which the
extrahepatic lesions are so high incidence compared to intrahepatic?
2. In the tables that are gathered the characteristics of the patients present
incidentalomas we observe that there is a high percentage of male. It does mean
that these findings regard more the male than the female? Please, clarify this
point.
3. In the table 4, where the authors shown the univariate Cox proportional
hazards regression analysis for predicting liver transplantation there are different
groups; White, African American, Asian Hispanic/Latino, Other Race. In the
table 5, that multivariate Cox proportional hazards regression analysis for
predicting liver transplantation the authors shown only two of the above race,
white and Hispano/Latino. It should be interesting if they add also the other
groups.
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.
No
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 publish my name with my
report.
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?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
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