Review for 10.1186/s12876-020-01427-4 (2020)

Reviewer’ s report
Title: Low mean fluorescence intensity donor-specific class II antibodies can also cause
complications after liver transplant
Version: 1Date: 21 May 2020
Reviewer's report:
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The authors have reviewed a series of 430 liver transplants from their center and measured donor-
specific alloantibody in them, finding positive results in 81 of these. The presence of alloantibodywas more common in patients with cirrhosis after liver transplantation, and in particular high MFIclass 2 antibody. The authors suggest that the presence of this antibody is a risk factor fordevelopment of cirrhosis. Other complications were not more common in the population ofpatients.
Critique:
The data support the conclusions. I would suggest a minor addition to the discussion as follows:The causal relationship between class 2 DSA and cirrhosis is not clear from the data. It may bethat the healthy liver is capable of clearing class 2 DSA while the cirrhotic liver loses this capacity.Or it may be that class 2 antibody contributes to development of cirrhosis. In other words whichcondition leads to the other is not possible to infer from the data. There is simply an association of
cirrhosis and elevated class 2 antibody.
Are the methods appropriate and well described?
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YesDoes the work include the necessary controls?
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YesAre the conclusions drawn adequately supported by the data shown?
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YesAre you able to assess any statistics in the manuscript or would you recommend an
additional statistical review?
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I am able to assess the statisticsQuality of written English
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Acceptable
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