Review for 10.1186/s12876-021-01703-x (2021)

Reviewer’s report
Title: 
Liver Transplantation in Adult Polycystic Liver Disease: The Ontario Experience.
Version: 
0 
Date: 
20 Dec 2020
Reviewer's report:
BMGE-D-20-01381
Title:
Full Title: Liver Transplantation in Adult Polycystic Liver Disease: The Ontario Experience.
Corresponding Author:
Mayur Brahmania MD FRCPC MPH
The authors present a retrospective data analysis about the Ontaria experience in a 17 years follow-up.
Among 3560 LT patients 1.4% (51 pats.) were transplanted for Adult Polycystic Liver Disease (PCLD)
due to symptoms of mass effect. All patients (84% were female) gained exceptional MELD points due to
underlying disease at time of transplantation. Nine patients suffered of combined liver and kidney
polycystic disease. A follow-up of median 6.3 years, the probability of survival was 96%.
The authors concluded that LT for PCLD has an excellent long-term survival.
The manuscript is well written. The introduction provides an good overview about the the current status.
The data are well presented and easy to follow. The statistic which is used is adequate.
the results are discussed in the context of other authors. Differing results are discussed in detail.
However, there are some concerns:
1. The authors stated that they lost 1 patient during follow up, not related to transplant. What was the
reason for death?
2. The authors reported about 9 patients suffering for both Liver and kidney polycystic disease.
3. How many patients suffered from any kind of infection caused by the cysts, what is the main casue of
death in this patient cohort?
4. What about drug treatment before Tx:
a. E.g.Somatostatin analogues
b. mTOR inhibitor
c. Vaptans
5. How many patients received an intervention before Tx like percutaneous drainage
6. Surgical treatment like
a. Fenestration
b. Hepatic resection
7. I congratulate the whole team for these excellent results. However, the most important question
remains: Excellent results in PCLD and LTX are well known for more than 15 years. From my point of
view the data do not provide something new. It only confirms the former data with > 90% survival after 5
years.
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