Review for 10.1186/s12876-022-02379-7 (2022)

Reviewer’s report
Title: 
Incidentalomas Are Associated with an Increase in Liver Transplantation
in Patients with Cirrhosis: A Single-Center Retrospective Study
Version: 
0 
Date: 
01 May 2022
Reviewer: 
Konstantina Kyritsi
Reviewer's report:
In this manuscript the authors study the role of incidentalomas, that are defined
as incidental findings of imaging, on liver transplantation. For their studies the
authors gather the data from 720 patients affected by NASH, HCV and alcohol,
liver disease, that underwent in surgery and performed survival analysis utilizing
Kaplan Meier and Cox proportional hazards regression analysis to determine
factors that are associated with liver transplantation. They shown that
incidentaloma was associated with a 30% increase in the risk of liver
transplantation. Patients with cirrhosis from alcohol or HCV had a significantly
shorter median time to transplantation than patients with NASH and
incidentalomas are common in patients affected by cirrhosis.
Please address the following points for proceed with this paper publication:
1. In their work the authors discover that of 690 extrahepatic lesions were found
amongst 720 patients, approximately 80% of patients had an incidentaloma
discovered, and 106 patients (18.5%) had more than one extrahepatic
incidentaloma. Could the authors speculate about the reason by which the
extrahepatic lesions are so high incidence compared to intrahepatic?
2. In the tables that are gathered the characteristics of the patients present
incidentalomas we observe that there is a high percentage of male. It does mean
that these findings regard more the male than the female? Please, clarify this
point.
3. In the table 4, where the authors shown the univariate Cox proportional
hazards regression analysis for predicting liver transplantation there are different
groups; White, African American, Asian Hispanic/Latino, Other Race. In the
table 5, that multivariate Cox proportional hazards regression analysis for
predicting liver transplantation the authors shown only two of the above race,
white and Hispano/Latino. It should be interesting if they add also the other
groups.
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