Reviewer ’s report  
 
Title: Proteinuria and Baseline Renal Function Predict Mortality and Renal Outcomes after 
Sirolimus Therapy in Liver Transplantation Recipient s 
 
Version: 0 Date: 01 Jan 2017  
 
Reviewer: Shahid Malik  
 
Reviewer's report:  
 
CRI is a major issue in LT recipients  stage 4/5 affecting up to 1/5 patients at 5 year follow up  
SRL may be an alternative  however the protective role is inconclusive  authors examined 576 
adult LT recipients receiving SRL conversio n (From FK)  10 year period  primary endpoint being 
incidence of GFR less than 50% and dialysis  secondary endpoints mortality and development of 
proteinuria  
1. extremely well written  
2. clear and concise  
3. a very important topic  
4. I especially appreciate the algorithm (figure 4a) recommendations  
 
Limitations  
The etiology of live disease (HBV accounting for > 50%) is obviously very different than a 
Western Cohort  (there were no NASH patients)  but the incidence of baseline diabetes  was 25%  
ideally a control of patient's remaining on FK would have been nice  
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.  
 
Unable to assess  
 
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 manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify 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:  
 
Acceptable  
 
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 receiv ed 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 i n 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 n o competing interests'  
 
I agree to the open peer re view 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 posted 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 included 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: Proteinuria and Baseline Renal Function Predict Mortality and Renal Outcomes after 
Sirolimus Therapy in Liver Transplantation Recipient s 
 
Version: 0 Date: 01 Jan 2017  
 
Reviewer: Shahid Malik  
 
Reviewer's report:  
 
CRI is a major issue in LT recipients  stage 4/5 affecting up to 1/5 patients at 5 year follow up  
SRL may be an alternative  however the protective role is inconclusive  authors examined 576 
adult LT recipients receiving SRL conversio n (From FK)  10 year period  primary endpoint being 
incidence of GFR less than 50% and dialysis  secondary endpoints mortality and development of 
proteinuria  
1. extremely well written  
2. clear and concise  
3. a very important topic  
4. I especially appreciate the algorithm (figure 4a) recommendations  
 
Limitations  
The etiology of live disease (HBV accounting for > 50%) is obviously very different than a 
Western Cohort  (there were no NASH patients)  but the incidence of baseline diabetes  was 25%  
ideally a control of patient's remaining on FK would have been nice  
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.  
 
Unable to assess  
 
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 manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify 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:  
 
Acceptable  
 
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 receiv ed 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 i n 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 n o competing interests'  
 
I agree to the open peer re view 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 posted 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 included 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: Proteinuria and Baseline Renal Function Predict Mortality and Renal Outcomes after 
Sirolimus Therapy in Liver Transplantation Recipient s 
 
Version: 0 Date: 01 Jan 2017  
 
Reviewer: Shahid Malik  
 
Reviewer's report:  
 
CRI is a major issue in LT recipients  stage 4/5 affecting up to 1/5 patients at 5 year follow up  
SRL may be an alternative  however the protective role is inconclusive  authors examined 576 
adult LT recipients receiving SRL conversio n (From FK)  10 year period  primary endpoint being 
incidence of GFR less than 50% and dialysis  secondary endpoints mortality and development of 
proteinuria  
1. extremely well written  
2. clear and concise  
3. a very important topic  
4. I especially appreciate the algorithm (figure 4a) recommendations  
 
Limitations  
The etiology of live disease (HBV accounting for > 50%) is obviously very different than a 
Western Cohort  (there were no NASH patients)  but the incidence of baseline diabetes  was 25%  
ideally a control of patient's remaining on FK would have been nice  
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.  
 
Unable to assess  
 
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 manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify 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:  
 
Acceptable  
 
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 receiv ed 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 i n 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 n o competing interests'  
 
I agree to the open peer re view 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 posted 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 included 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