Title: Impact of donor age on liver transplant outcomes in patients with hepatocellular
carcinoma: analysis of the SRTR database
Version: 2 Date: 26 Dec 2020
Reviewer's report:
The authors report data from the OPTN dataset including almost 13,300 transplant recipients
with HCC. The main aim of the study was to evaluate the impact of donor age on liver transplant
outcomes in patients with hepatocellular carcinoma. Not surprisingly, younger donor age was
associated with an improved survival, while donor age did not impact on HCC recurrence rate.
As attempts to increase the donor pool may lead to transplantation of older organs, the study
subject is interesting, however, the study has some significant drawbacks, which are outlined
below.
Major comments
- The authors did not specify the end of clinical follow-up. This must be added. Additionally,
and as older organs might be increasingly used in the last years, patients with a follow-up of less
than 24 months should be excluded from the primary analyses.
- Studies have indicated that choice of immunosuppressive treatment after liver transplantation
might impact on HCC recurrence. Therefore, HCC recurrence should be analyzed considering
immunosuppressive regimen as co-factor.
- Furthermore, presence or absence of vascular invasion should be considered as co-factor.
- Additionally, tumor biology (as indicated by Edmondson-Steiner grade) should be included
as co-factor.
- It should be stated that even though some differences were statistically significant due to
the large sample size, these differences might not be clinically relevant (e.g. 1-year survival
among the different groups: 91.4% vs. 90.6% vs. 89.5 vs. 89.2%). In line, the authors stated
that “donor age had slight effect on post-transplant tumor recurrence” – this is not supported
by the demonstrated data.
- English needs to be improved throughout the whole manuscript.
- Numbers at risk need to be included in all Kaplan-Meier curves.
Title: Impact of donor age on liver transplant outcomes in patients with hepatocellular
carcinoma: analysis of the SRTR database
Version: 2 Date: 26 Dec 2020
Reviewer's report:
The authors report data from the OPTN dataset including almost 13,300 transplant recipients
with HCC. The main aim of the study was to evaluate the impact of donor age on liver transplant
outcomes in patients with hepatocellular carcinoma. Not surprisingly, younger donor age was
associated with an improved survival, while donor age did not impact on HCC recurrence rate.
As attempts to increase the donor pool may lead to transplantation of older organs, the study
subject is interesting, however, the study has some significant drawbacks, which are outlined
below.
Major comments
- The authors did not specify the end of clinical follow-up. This must be added. Additionally,
and as older organs might be increasingly used in the last years, patients with a follow-up of less
than 24 months should be excluded from the primary analyses.
- Studies have indicated that choice of immunosuppressive treatment after liver transplantation
might impact on HCC recurrence. Therefore, HCC recurrence should be analyzed considering
immunosuppressive regimen as co-factor.
- Furthermore, presence or absence of vascular invasion should be considered as co-factor.
- Additionally, tumor biology (as indicated by Edmondson-Steiner grade) should be included
as co-factor.
- It should be stated that even though some differences were statistically significant due to
the large sample size, these differences might not be clinically relevant (e.g. 1-year survival
among the different groups: 91.4% vs. 90.6% vs. 89.5 vs. 89.2%). In line, the authors stated
that “donor age had slight effect on post-transplant tumor recurrence” – this is not supported
by the demonstrated data.
- English needs to be improved throughout the whole manuscript.
- Numbers at risk need to be included in all Kaplan-Meier curves.
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: 26 Dec 2020
Reviewer's report:
The authors report data from the OPTN dataset including almost 13,300 transplant recipients
with HCC. The main aim of the study was to evaluate the impact of donor age on liver transplant
outcomes in patients with hepatocellular carcinoma. Not surprisingly, younger donor age was
associated with an improved survival, while donor age did not impact on HCC recurrence rate.
As attempts to increase the donor pool may lead to transplantation of older organs, the study
subject is interesting, however, the study has some significant drawbacks, which are outlined
below.
Major comments
- The authors did not specify the end of clinical follow-up. This must be added. Additionally,
and as older organs might be increasingly used in the last years, patients with a follow-up of less
than 24 months should be excluded from the primary analyses.
- Studies have indicated that choice of immunosuppressive treatment after liver transplantation
might impact on HCC recurrence. Therefore, HCC recurrence should be analyzed considering
immunosuppressive regimen as co-factor.
- Furthermore, presence or absence of vascular invasion should be considered as co-factor.
- Additionally, tumor biology (as indicated by Edmondson-Steiner grade) should be included
as co-factor.
- It should be stated that even though some differences were statistically significant due to
the large sample size, these differences might not be clinically relevant (e.g. 1-year survival
among the different groups: 91.4% vs. 90.6% vs. 89.5 vs. 89.2%). In line, the authors stated
that “donor age had slight effect on post-transplant tumor recurrence” – this is not supported
by the demonstrated data.
- English needs to be improved throughout the whole manuscript.
- Numbers at risk need to be included in all Kaplan-Meier curves.
assistant