Bacterial Infections in End-Stage Liver Disease: Implications for Liver Transplantation

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This manuscript offers a comprehensive and meticulously detailed review of the complex interplay between bacterial infections and end-stage liver disease, particularly emphasizing the nuanced implications for liver transplantation. The authors evaluated and gathered  many data into an accessible and clinically relevant synthesis that advances our understanding of the challenges faced by patients with decompensated cirrhosis. Notably, the discussion on the multifaceted nature of diagnostic challenges and the tailored therapeutic approaches provides valuable insights for both the clinical and research communities. The careful consideration of prognostic implications, along with the balanced view on the impact of pre-transplant infections on postoperative outcomes, adds to the strengths of this article. The work is a testament to the collaborative efforts of the research team and represents a significant contribution to the field of transplantology.

Author Response

We would like to thank The Reviewer for the comment and for appreciating this review paper.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

This is a review article describing the relation between the infection and transplantation.

I have some comments.

1.        Where is the consequent subsection to “2.1 Epidemiology and risk factors”?

2.        Is reference 30 a manuscript? In general the infection itself (regardless of its severity) is regarded as contraindication to transplantation.

Comments on the Quality of English Language

 None

Author Response

I would like to thank for the comments regarding this manuscript.

Please see the attachment where a point-by-point response has been provided to the Editorial Office and the Reviewers.

Best regards.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

This short narrative review summarizes the problem of bacterial infection in ESLD. I only have a few remakrs

Section 2.1

-l70: where are the unusual sites? Is there any data? This might help clinicians to be more alert

-L72ff: this is probably due to catheter-associated infections, that tend to be linked to g+-bacteria.

-Is there anything new regarding MDR? Its common knowledge, that they form a rising problem, specifications here might be interesting

-L88: I would suggest to specify to “rectal colonization with resistant bacteria”

-L100ff: this paragraph describes common practice in severerly ill patients and for new generation antibiotics, data is scarce

 

Section 3

-There seems to be nothing new regarding the first issue the authors mention, as this is one of the most difficult situation in these patients: to transplant or not to transplant, and when. Are there any new recommendations?

-The second issue is one of the most interesting, but sadly the shortest discussed: is there new data or ongoing projects investigating infections and their “impact” on climbing up the waiting list? It is a clinically interesting approach.

-l192: n=84

-the issue of infection and post-transplant outcome is the most important one; it is important to distinguigh between e.g. a urinary tract infection that was treated a few weeks before LT and severe (bloodstream) infections. I fear that retrospective data tend to inherit this bias and this is why outcome after LT is comparable. Source 41 is very important in this context – a little in depth-discussion regarding this problem might be helpful

Comments on the Quality of English Language

English is mostly fine but could benefit from an additional revision.

Author Response

I would like to thank for the comments regarding this manuscript.

Please see the attachment where a point-by-point response has been provided to the Editorial Office and Reviewers.

Best regards.

Author Response File: Author Response.pdf

Reviewer 4 Report

Comments and Suggestions for Authors

This is a well-written, concise, short review of bacterial infections in patients with cirrhosis, with a focus on the implications on overall patient outcomes as well as transplant-related outcomes. There are a few recommendations:

- Suggest revision of title, such as - "Bacterial infections in end-stage liver disease: implications for liver transplantation"

- Lines 80-81, regarding multidrug-resistant strains - would also add that MDR infections, or even colonization by such organisms, have implications for post-transplant recovery and prognosis.

- Lines 97-98 - "Therefore, the administration of long-term antibiotic prophylaxis remains both cost-effective and reduces the risk of further infections." - would clarify this sentence such that antibiotic prophylaxis is only indicated in certain selected patient populations, and still carries the risk of promoting drug resistant bacterial strains.

Comments on the Quality of English Language

minor edits needed

Author Response

I would like to thank for the comments regarding this manuscript.

Please see the attachment where a point-by-point response has been provided to the Editorial Office and Reviewers.

Best regards.

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

This is a review article describing the relation between the infection and transplantation.

I have some comments.

1. (L242) What is ACLF-3? Please identify it.

2. (L325) Please add LT for abbreviations list.

Author Response

We would like to thank for the comments.

We have modified the text, as requested.

Regards.