Reviewer ’s report  
Title: Pancreas grafts for transplantation from donors with h ypertension: An analysis of the 
Scientific Registry of Transplant Recipients database  
 
Version: 0 Date: 28 Mar 2018  
 
Reviewer: Quirino Lai  
 
Reviewer's report:  
Title: Pancreas grafts for transplantation from donors with hypertension: An analysis of the 
Scientific Registry of Transplant Recipients database (BMGE -D-18-00161)  
 
This is an interesting retrospective analysis performed on a large natio nal (USA) database 
composed by 24,192 pancreatic transplant recipients. The aim of the study was to investigate the 
role of donor hypertension as a possible risk factor for patient and graft survival after transplant.  
The study is of interest. The idea is novel. This is a further confirmation of the fact that donor 
quality represents a capital aspect to consider when a transplant is performed. A more accurate 
selection approach should be suggested according to the results of the present study. The paper 
should be further ameliorated and more analyses are required.  
 
I have some comments:  
1. English quality should be ameliorated, so an extensive review of the text is required.  
2. The median follow -up period of the entire population must be reported.  
3. In Met hods (Population characteristics) there are some results: I think it is necessary to 
move these data to the Results part.  
4. Discussion starts reporting the results connected to BMI and the different types of pancreas 
transplant (SPK vs. PA or PAK): the m ain argument of this paper is the role of donor 
hypertension, so it is better to start talking about this, and then to analyse the other aspects.   
5. I think another Cox regression analysis should be done also investigating the role of donor 
hypertension duration: in other terms, it should be possible to categorize the population in 
no HTN vs. 0 -5yr HTN vs. >5yr HTN with the intent to find a gradual increase of the HRs. 
This analysis should be easy to do and of additive interest.  
6. No information about t he use of anti -HTN drugs in the donors? Also if the information is 
available in only a part of the population, it should be interesting to look also at this datum. I 
understand that this datum is really unpolished, but it should add further information in 
selecting the patients.  
7. An analysis combining donor age and HTN can further be done: is there an upper limit of 
unacceptable selection for transplantation? I think also this information is needed.  
8. How the variables were selected for the multivariab le analysis? Several donor - and 
recipient -related aspects were significant, so I think that a univariable analysis should be 
first done and then a selection of variables should be done for the multivariable analysis.  
9. How the variables with missing data  were handled?  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
Yes 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
Yes 
Are the conclusions drawn adequately supported  by the data shown?  
If not, please explain in your comments to the authors.  
Yes 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please spec ify what aspects require further 
assessment in your comments to the editors.  
I am able to assess the statistics  
Quality of written English  
Please indicate the quality of language in the manuscript:  
Needs some language corrections before being published  
 
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 financial ly from the publication of this 
manuscript, either now or in the future?  
2. Do you hold any stocks or shares in an organisation t hat 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 comp eting interests'  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be pos ted on the website along with the authors' 
responses. 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/ ). I understand that any comments 
which I do not wish to be inc luded in my named report can be included as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
Title: Pancreas grafts for transplantation from donors with h ypertension: An analysis of the 
Scientific Registry of Transplant Recipients database  
 
Version: 0 Date: 28 Mar 2018  
 
Reviewer: Quirino Lai  
 
Reviewer's report:  
Title: Pancreas grafts for transplantation from donors with hypertension: An analysis of the 
Scientific Registry of Transplant Recipients database (BMGE -D-18-00161)  
 
This is an interesting retrospective analysis performed on a large natio nal (USA) database 
composed by 24,192 pancreatic transplant recipients. The aim of the study was to investigate the 
role of donor hypertension as a possible risk factor for patient and graft survival after transplant.  
The study is of interest. The idea is novel. This is a further confirmation of the fact that donor 
quality represents a capital aspect to consider when a transplant is performed. A more accurate 
selection approach should be suggested according to the results of the present study. The paper 
should be further ameliorated and more analyses are required.  
 
I have some comments:  
1. English quality should be ameliorated, so an extensive review of the text is required.  
2. The median follow -up period of the entire population must be reported.  
3. In Met hods (Population characteristics) there are some results: I think it is necessary to 
move these data to the Results part.  
4. Discussion starts reporting the results connected to BMI and the different types of pancreas 
transplant (SPK vs. PA or PAK): the m ain argument of this paper is the role of donor 
hypertension, so it is better to start talking about this, and then to analyse the other aspects.   
5. I think another Cox regression analysis should be done also investigating the role of donor 
hypertension duration: in other terms, it should be possible to categorize the population in 
no HTN vs. 0 -5yr HTN vs. >5yr HTN with the intent to find a gradual increase of the HRs. 
This analysis should be easy to do and of additive interest.  
6. No information about t he use of anti -HTN drugs in the donors? Also if the information is 
available in only a part of the population, it should be interesting to look also at this datum. I 
understand that this datum is really unpolished, but it should add further information in 
selecting the patients.  
7. An analysis combining donor age and HTN can further be done: is there an upper limit of 
unacceptable selection for transplantation? I think also this information is needed.  
8. How the variables were selected for the multivariab le analysis? Several donor - and 
recipient -related aspects were significant, so I think that a univariable analysis should be 
first done and then a selection of variables should be done for the multivariable analysis.  
9. How the variables with missing data  were handled?  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
Yes 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
Yes 
Are the conclusions drawn adequately supported  by the data shown?  
If not, please explain in your comments to the authors.  
Yes 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please spec ify what aspects require further 
assessment in your comments to the editors.  
I am able to assess the statistics  
Quality of written English  
Please indicate the quality of language in the manuscript:  
Needs some language corrections before being published  
 
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 financial ly from the publication of this 
manuscript, either now or in the future?  
2. Do you hold any stocks or shares in an organisation t hat 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 comp eting interests'  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be pos ted on the website along with the authors' 
responses. 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/ ). I understand that any comments 
which I do not wish to be inc luded in my named report can be included as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
Title: Pancreas grafts for transplantation from donors with h ypertension: An analysis of the 
Scientific Registry of Transplant Recipients database  
 
Version: 0 Date: 28 Mar 2018  
 
Reviewer: Quirino Lai  
 
Reviewer's report:  
Title: Pancreas grafts for transplantation from donors with hypertension: An analysis of the 
Scientific Registry of Transplant Recipients database (BMGE -D-18-00161)  
 
This is an interesting retrospective analysis performed on a large natio nal (USA) database 
composed by 24,192 pancreatic transplant recipients. The aim of the study was to investigate the 
role of donor hypertension as a possible risk factor for patient and graft survival after transplant.  
The study is of interest. The idea is novel. This is a further confirmation of the fact that donor 
quality represents a capital aspect to consider when a transplant is performed. A more accurate 
selection approach should be suggested according to the results of the present study. The paper 
should be further ameliorated and more analyses are required.  
 
I have some comments:  
1. English quality should be ameliorated, so an extensive review of the text is required.  
2. The median follow -up period of the entire population must be reported.  
3. In Met hods (Population characteristics) there are some results: I think it is necessary to 
move these data to the Results part.  
4. Discussion starts reporting the results connected to BMI and the different types of pancreas 
transplant (SPK vs. PA or PAK): the m ain argument of this paper is the role of donor 
hypertension, so it is better to start talking about this, and then to analyse the other aspects.   
5. I think another Cox regression analysis should be done also investigating the role of donor 
hypertension duration: in other terms, it should be possible to categorize the population in 
no HTN vs. 0 -5yr HTN vs. >5yr HTN with the intent to find a gradual increase of the HRs. 
This analysis should be easy to do and of additive interest.  
6. No information about t he use of anti -HTN drugs in the donors? Also if the information is 
available in only a part of the population, it should be interesting to look also at this datum. I 
understand that this datum is really unpolished, but it should add further information in 
selecting the patients.  
7. An analysis combining donor age and HTN can further be done: is there an upper limit of 
unacceptable selection for transplantation? I think also this information is needed.  
8. How the variables were selected for the multivariab le analysis? Several donor - and 
recipient -related aspects were significant, so I think that a univariable analysis should be 
first done and then a selection of variables should be done for the multivariable analysis.  
9. How the variables with missing data  were handled?  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
Yes 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
Yes 
Are the conclusions drawn adequately supported  by the data shown?  
If not, please explain in your comments to the authors.  
Yes 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please spec ify what aspects require further 
assessment in your comments to the editors.  
I am able to assess the statistics  
Quality of written English  
Please indicate the quality of language in the manuscript:  
Needs some language corrections before being published  
 
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 financial ly from the publication of this 
manuscript, either now or in the future?  
2. Do you hold any stocks or shares in an organisation t hat 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 comp eting interests'  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be pos ted on the website along with the authors' 
responses. 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/ ). I understand that any comments 
which I do not wish to be inc luded in my named report can be included as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant