Review for 10.1186/s12876-019-1077-y (2019)

Reviewer’s report
Title:  Extracorporeal liver support: trending epidemiology and mortality - A nationwide database  
analysis 2007-2015
Version: 0 Date: 27 May 2019
Reviewer: Norman Leslie Sussman
Reviewer's report:
The manuscript by Wiesmann et al. describes the use of extracorporeal liver support in Germany from  
2007 to 2015.  The paper is interesting in that it demonstrates the ongoing use of an expensive  
technology that has no proven benefit, demonstrated by several controlled trials, and referenced in this  
manuscript.  To their credit, the authors suggest that ELS be used only in clinical trials. As an aside, I  
feel that purification devices such as MARS should not be termed liver support since they have no liver  
function.  
The weaknesses of the paper are the limitations of the data as acknowledged by the authors.
The paper will benefit from minor editorial revisions.
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 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.
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 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 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 have received funding for a stem cell project that may eventually allow us to develop a bioartificial  
liver - I do not consider this a major conflict.
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 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