Review for 10.1186/s12876-017-0611-z (2017)

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: 24 Jan 2017  
 
Reviewer: Jawad Ahmad  
 
Reviewer's report:  
This is a single center, retrospective cohort study of 576 liver transplant recipients treated with 
sirolimus as renal sparing therapy. Using a Cox proportional hazard model, the authors 
determined that new onset proteinuria within the first year was asso ciated with a risk of 
worsening renal function and pre -existing and new onset diabetes were associated with new 
onset proteinuria among sirolimus users.  
I have several comments and questions.  
1. It would be interesting to see the rate of proteinuria and r enal dysfunction in patients who 
continued with tacrolimus or cyclosporine based regimens, particularly if they had 
underlying diabetes.  
 
2. The conclusion states that more effective monitoring and early management of predictive 
risks for proteinuria should  be developed. Do you have data on how the proteinuria and 
diabetes were managed - ACEI and glycemic control measures? For instance, in patients with 
new onset proteinuria, could their renal function be preserved with therapy? Was sirolimus 
dose adjusted or  stopped because of proteinuria and did it improve?  
 
3. Was there any abdominal imaging describing what the kidneys looked like? Was there any 
indication of small kidneys indicating chronic medical disease?  
 
4. Your cohort lacks patients with NASH or cryptog enic cirrhosis who are more likely to have 
underlying renal dysfunction. It would be worth commenting on this in the discussion.  
 
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.  
 
Yes 
 
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  
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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?  
 
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below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
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