Reviewer ’s report  
 
Title: Case report of Hepatic artery dissection secondary to hepatic artery pseudoaneurysm after 
living donor liver transplantation  
 
 
Version: 0 Date: 08 Oct 2015  
 
 
Reviewer: Renumathy Dhanasekaran  
 
 
Reviewer's report:  
 
In this case report the authors present an interesting case of dissecting hepatic artery aneurysm in 
a patient who i s s/p living donor liver transplantation. But there are several crucial details which 
are not clear hence the review cannot be accepted in its current form. The following are some of 
the criticisms:  
 
 
1. The patient is a young male who received a LDLT for a cute hep B. And the case report 
mentions that the patient remained in the ICU for 50 days for "abnormal liver function test 
results and high total bilirubin level and malnutrition" but no explanation is provided for this 
high bilirubin or abnormal liver te sts. Was he having acute rejection. Were liver biopsies 
performed?What other testing were performed.  
 
 
2. The patient underwent a doppler ultrasound followed by CEUS followed by CECT and then a 
DSA to diagnose the HA pseudoaneurysm. If suspicion was high on  doppler ultrasound then why 
not directly go for a definitive imaging like CECT?  
 
 
3. The patient was diagnosed with HA dissection during laparotomy. This appears to have 
occurred 2 days after the attempted HA angioplasty with stent placement and embolizati on. The 
dissection is most likely a result of iatrogenic injury to HA intima layer during the intervention. 
The authors do not discuss this adequately.  
 
 
4. The cause of death is mentioned as multi organ failure but the details of why this patient 
developed  multiple infections, including infections in the lung, is not mentioned.  
 
 
5. Details of immunosuppression is not mentioned. Was sirolimus used.  
 
6. The main premise of the case report is that no such report exists so far in literature. We found 
several case reports of HA pseudoaneurysm in LDLT on our literature review. Obviously it is a 
rare arterial complication of liver transplantation but is not  unheard of. And secondly the hepatic 
artery dissection and thrombosis are both likely to be secondary to iatrogenic injury following 
angioplasty and attempted stenting. Dissection is a known complication of HA interventions so 
this is not novel either. Ov erall the conclusions from the case report are felt to be too strong.  
 
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.  
 
No 
 
Are the conclusions drawn adequat ely supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
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.  
 
Not relevant to this manuscript  
 
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 financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares i n 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 receive d 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 competing interests  
 
I agree to the open peer review policy of the journ al. 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: Case report of Hepatic artery dissection secondary to hepatic artery pseudoaneurysm after 
living donor liver transplantation  
 
 
Version: 0 Date: 08 Oct 2015  
 
 
Reviewer: Renumathy Dhanasekaran  
 
 
Reviewer's report:  
 
In this case report the authors present an interesting case of dissecting hepatic artery aneurysm in 
a patient who i s s/p living donor liver transplantation. But there are several crucial details which 
are not clear hence the review cannot be accepted in its current form. The following are some of 
the criticisms:  
 
 
1. The patient is a young male who received a LDLT for a cute hep B. And the case report 
mentions that the patient remained in the ICU for 50 days for "abnormal liver function test 
results and high total bilirubin level and malnutrition" but no explanation is provided for this 
high bilirubin or abnormal liver te sts. Was he having acute rejection. Were liver biopsies 
performed?What other testing were performed.  
 
 
2. The patient underwent a doppler ultrasound followed by CEUS followed by CECT and then a 
DSA to diagnose the HA pseudoaneurysm. If suspicion was high on  doppler ultrasound then why 
not directly go for a definitive imaging like CECT?  
 
 
3. The patient was diagnosed with HA dissection during laparotomy. This appears to have 
occurred 2 days after the attempted HA angioplasty with stent placement and embolizati on. The 
dissection is most likely a result of iatrogenic injury to HA intima layer during the intervention. 
The authors do not discuss this adequately.  
 
 
4. The cause of death is mentioned as multi organ failure but the details of why this patient 
developed  multiple infections, including infections in the lung, is not mentioned.  
 
 
5. Details of immunosuppression is not mentioned. Was sirolimus used.  
 
6. The main premise of the case report is that no such report exists so far in literature. We found 
several case reports of HA pseudoaneurysm in LDLT on our literature review. Obviously it is a 
rare arterial complication of liver transplantation but is not  unheard of. And secondly the hepatic 
artery dissection and thrombosis are both likely to be secondary to iatrogenic injury following 
angioplasty and attempted stenting. Dissection is a known complication of HA interventions so 
this is not novel either. Ov erall the conclusions from the case report are felt to be too strong.  
 
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.  
 
No 
 
Are the conclusions drawn adequat ely supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
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.  
 
Not relevant to this manuscript  
 
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 financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares i n 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 receive d 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 competing interests  
 
I agree to the open peer review policy of the journ al. 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: Case report of Hepatic artery dissection secondary to hepatic artery pseudoaneurysm after 
living donor liver transplantation  
 
 
Version: 0 Date: 08 Oct 2015  
 
 
Reviewer: Renumathy Dhanasekaran  
 
 
Reviewer's report:  
 
In this case report the authors present an interesting case of dissecting hepatic artery aneurysm in 
a patient who i s s/p living donor liver transplantation. But there are several crucial details which 
are not clear hence the review cannot be accepted in its current form. The following are some of 
the criticisms:  
 
 
1. The patient is a young male who received a LDLT for a cute hep B. And the case report 
mentions that the patient remained in the ICU for 50 days for "abnormal liver function test 
results and high total bilirubin level and malnutrition" but no explanation is provided for this 
high bilirubin or abnormal liver te sts. Was he having acute rejection. Were liver biopsies 
performed?What other testing were performed.  
 
 
2. The patient underwent a doppler ultrasound followed by CEUS followed by CECT and then a 
DSA to diagnose the HA pseudoaneurysm. If suspicion was high on  doppler ultrasound then why 
not directly go for a definitive imaging like CECT?  
 
 
3. The patient was diagnosed with HA dissection during laparotomy. This appears to have 
occurred 2 days after the attempted HA angioplasty with stent placement and embolizati on. The 
dissection is most likely a result of iatrogenic injury to HA intima layer during the intervention. 
The authors do not discuss this adequately.  
 
 
4. The cause of death is mentioned as multi organ failure but the details of why this patient 
developed  multiple infections, including infections in the lung, is not mentioned.  
 
 
5. Details of immunosuppression is not mentioned. Was sirolimus used.  
 
6. The main premise of the case report is that no such report exists so far in literature. We found 
several case reports of HA pseudoaneurysm in LDLT on our literature review. Obviously it is a 
rare arterial complication of liver transplantation but is not  unheard of. And secondly the hepatic 
artery dissection and thrombosis are both likely to be secondary to iatrogenic injury following 
angioplasty and attempted stenting. Dissection is a known complication of HA interventions so 
this is not novel either. Ov erall the conclusions from the case report are felt to be too strong.  
 
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.  
 
No 
 
Are the conclusions drawn adequat ely supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
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.  
 
Not relevant to this manuscript  
 
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 financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares i n 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 receive d 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 competing interests  
 
I agree to the open peer review policy of the journ al. 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