Title: Changing Trends in Liver Transplantation Indications in Saudi Arabia: From Hepatitis C
Virus Infection to Nonalcoholic Fatty Liver Disease
Version: 2 Date: 03 Apr 2021
Reviewer's report:
GENERAL COMMENT
The Authors performed an original, timely and interesting study on trends in Liver
Transplantation Indications in Saudi Arabia showing that NAFLD has eclipsed HCV as main
indication. This is an hot topic. Some comments maybe raised at improving the quality of the
manuscript.
SPECIFIC COMMENTS
Literature about NAFLD should be updated. The strong bidirectional relationship with metabolic
comorbidities and the risk of cardiovascular disease morbidity and mortality should be
stressed. NAFLD and its severity (steatosis grade/fibrosis severity) have been associated with
cardiovascular risk. A growing mole of patients will with advanced NAFLD and cardiometabolic
disease will be observed. Moreover, a sexual dimorphism has been recently recognized in
NAFLD.
Based on these premises, we agree with the Authors that an active policy finding of NAFLD in
high risk-individuals should be advoked to better allocate resources.
Suggested updated literature:
Lonardo A, Int J Mol Sci. 2020;21:5888.
Cotter TG, Gastroenterology 2020;158:1851-1864.
Targher G, J Hepatol. 2016;65:589-600.
Cai J, Circ Res. 2020;126:679–704
Ballestri S, Diagnostics (Basel) 2021;11:98.
Lonardo A, Hepatology. 2019;70:1457-1469.
Noureddin M, Gastroenterology 2020;159:1985-1987.e4.
Title: Changing Trends in Liver Transplantation Indications in Saudi Arabia: From Hepatitis C
Virus Infection to Nonalcoholic Fatty Liver Disease
Version: 2 Date: 03 Apr 2021
Reviewer's report:
GENERAL COMMENT
The Authors performed an original, timely and interesting study on trends in Liver
Transplantation Indications in Saudi Arabia showing that NAFLD has eclipsed HCV as main
indication. This is an hot topic. Some comments maybe raised at improving the quality of the
manuscript.
SPECIFIC COMMENTS
Literature about NAFLD should be updated. The strong bidirectional relationship with metabolic
comorbidities and the risk of cardiovascular disease morbidity and mortality should be
stressed. NAFLD and its severity (steatosis grade/fibrosis severity) have been associated with
cardiovascular risk. A growing mole of patients will with advanced NAFLD and cardiometabolic
disease will be observed. Moreover, a sexual dimorphism has been recently recognized in
NAFLD.
Based on these premises, we agree with the Authors that an active policy finding of NAFLD in
high risk-individuals should be advoked to better allocate resources.
Suggested updated literature:
Lonardo A, Int J Mol Sci. 2020;21:5888.
Cotter TG, Gastroenterology 2020;158:1851-1864.
Targher G, J Hepatol. 2016;65:589-600.
Cai J, Circ Res. 2020;126:679–704
Ballestri S, Diagnostics (Basel) 2021;11:98.
Lonardo A, Hepatology. 2019;70:1457-1469.
Noureddin M, Gastroenterology 2020;159:1985-1987.e4.
Please review this paper.
user
Title: Changing Trends in Liver Transplantation Indications in Saudi Arabia: From Hepatitis C
Virus Infection to Nonalcoholic Fatty Liver Disease
Version: 2 Date: 03 Apr 2021
Reviewer's report:
GENERAL COMMENT
The Authors performed an original, timely and interesting study on trends in Liver
Transplantation Indications in Saudi Arabia showing that NAFLD has eclipsed HCV as main
indication. This is an hot topic. Some comments maybe raised at improving the quality of the
manuscript.
SPECIFIC COMMENTS
Literature about NAFLD should be updated. The strong bidirectional relationship with metabolic
comorbidities and the risk of cardiovascular disease morbidity and mortality should be
stressed. NAFLD and its severity (steatosis grade/fibrosis severity) have been associated with
cardiovascular risk. A growing mole of patients will with advanced NAFLD and cardiometabolic
disease will be observed. Moreover, a sexual dimorphism has been recently recognized in
NAFLD.
Based on these premises, we agree with the Authors that an active policy finding of NAFLD in
high risk-individuals should be advoked to better allocate resources.
Suggested updated literature:
Lonardo A, Int J Mol Sci. 2020;21:5888.
Cotter TG, Gastroenterology 2020;158:1851-1864.
Targher G, J Hepatol. 2016;65:589-600.
Cai J, Circ Res. 2020;126:679–704
Ballestri S, Diagnostics (Basel) 2021;11:98.
Lonardo A, Hepatology. 2019;70:1457-1469.
Noureddin M, Gastroenterology 2020;159:1985-1987.e4.
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