Pancreas Transplantation in Minorities including Patients with a Type 2 Diabetes Phenotype

Round 1

Reviewer 1 Report

This review addresses the problem of pancreas transplantation in the unconventional population with type II DM in the new millenium.
The question is original and well-defined.The article is very well written and the data and analyses presented appropriately.
The conclusions are very interesting for the readers.

 

Author Response

Thank you very much for the opportunity to revise manuscript review ID uro-1896063 entitled “Pancreas Transplantation in Minorities Including Patients with a Type 2 Diabetes Phenotype” by Stratta and Gruessner.   We appreciate the insightful comments of the editors and reviewers.  A summary of specific revisions follows and each revision has been bolded and underlined in the revised manuscript.

This review addresses the problem of pancreas transplantation in the unconventional population with type 2 DM in the new millennium.  The question is original and well-defined.  The article is very well written and the data and analyses presented appropriately.  The conclusions are very interesting for the readers.

Response:  Thank you for your kind comments.  Respectfully, we do not identify pancreas transplantation as a problem, but rather as a solution. 

Reviewer 2 Report

This is a manuscript describing pancreas transplantation in minorities including patients with a type 2 Diabetes phenotype. It's a very interesting and full of data work. 

Corrections:
- Page 13, line 415 - 417: “In patients with T2DM, the incidences of kidney primary nonfunction    (1.03% T2DM versus 0.47% T1DM, p=0.03)”. The sentence is repeated two times.

- For C peptide: Use nmol/L or ng/m throughout the text. Es Page 11, line 329

- Page 19, line “12/31/07”; mistake?

Comments:
- Page 1 line 64: It would be useful to use new 2021 epidemiological diabetes data: es. Diabetesatlas.org (IDF 10^th Edition)

- Do exist data about the efficacy on microvascular diabetic complication in T2DM PTx?

- Are available data in renal function decrease after PTA in T2DM? If possible cite the article “Treating Type 1 Diabetes by Pancreas Transplant Alone: a Cohort Study on Actual Long-Term (10 Years) Efficacy and Safety”

- Are there different in immunosuppression posology in T1DM PTx and T2DM PTx?

 

Kind Regards

Author Response

Thank you very much for the opportunity to revise manuscript review ID uro-1896063 entitled “Pancreas Transplantation in Minorities Including Patients with a Type 2 Diabetes Phenotype” by Stratta and Gruessner.   We appreciate the insightful comments of the editors and reviewers.  A summary of specific revisions follows and each revision has been bolded and underlined in the revised manuscript.

This is a manuscript describing pancreas transplantation in minorities including patients with a type 2 diabetes phenotype.  It’s a very interesting and full of data work.

Corrections: 

- Page 13, line 415-417:  “In patients with T2DM, the incidences of kidney primary nonfunction (1.03% T2DM versus 0.47% T1DM, p=0.03)”.  The sentence is repeated two times.

- For C-peptide:  Use nmol/L or ng/ml throughout the text.  Es. page 11, line 329.

- Page 19, line “12/31/07”; mistake?

Comments:

- Page 1 line 64:  It would be useful to use new 2021 epidemiological diabetes data.  Es. Diabetesatlas.org (IDF 10^th Edition).

- Do data exist about the efficacy on microvascular diabetic complications in T2DM PTx?

- Are data available in renal function decrease after PTA in T2DM?  If possible cite the article “Treating Type 1 Diabetes by Pancreas Transplant Alone:  a Cohort Study on Actual Long-Term (10 Years) Efficacy and Safety”.

- Are there differences in immunosuppression posology in T1DM PTx and T2DM PTx?

Response:  Thank you for your kind and insightful comments.  We have made the above 3 corrections in the manuscript.  We have updated the global epidemiological diabetes data and have changed reference #2 accordingly.  There are extremely limited data on PTA for T2DM, so we cannot really comment on the issues of microvascular diabetic complications or progression of kidney disease.  The seminal study cited above by Boggi, et al., is unique to T1DM.  There are no differences in immunosuppressive regimens or dosing specific to “type” of DM following SPKT, so we have added a sentence to this effect at the end of section 3 (now section 4) in the Text.

Reviewer 3 Report

Thanks for the opportunity to review this manuscript.

The Authors offers a juicy revied centered on pancreas transplantation, focusing type 2 diabetes patients. They analyze many works and report all relevant data in terms of epidemiology, survival and weight change. The manusctipt is clear and the structure is well organized. References are recent. There are some self-citations, but I believe they can be justified by the strong experience of the authors in this field, since they contributed a lot.

The choice to offer many graphics is the real strenght of the work, because it simplifies the reading and the understanding.

Nevertheless, I would like to clarify some points with the authors, to offer some suggestions and I hope they will apport some changes or (in alternative) express their point of view.

ABSTRACT

I believe that this section could be more schematic and less narrative. For example, they could use the structure “background, materials and methods, etc” or summarize/reducing its lenght. Not mandatory! Just a suggestion to make the text slighter.

INTRODUCTION

Line 64 “in 2014, 422 million”: could you replace it with more recent data? It is just a general epidemiology, I am sure you can find more updated numbers.

Table 1-2: actually they are not well identifiable. They can be actually confused with the rest of the text. Please change the layout.

GENERAL SUGGESTIONS

In many parts of the test the Authors emphasized the role of transplant on improving the quality of life. I think that a brief paragraph citing more relevant studies on quality of life after transplantation (or how to evaluate it) may play an interesting role in this work. Could you provide?

METHODOLOGY

It is clear that this work is structured as narrative review. Nevertheless, I think that a “methods section” is mandatory. In particular: how did they select all the cited works? Which inclusion/exclusion criteria were used? This question might be answered both in abstract (for example line 28: this narrative review…) and in an appropriate paragraph.

Thank you Authors for your contribution.

Best Regards.

Author Response

Thank you very much for the opportunity to revise manuscript review ID uro-1896063 entitled “Pancreas Transplantation in Minorities Including Patients with a Type 2 Diabetes Phenotype” by Stratta and Gruessner.   We appreciate the insightful comments of the editors and reviewers.  A summary of specific revisions follows and each revision has been bolded and underlined in the revised manuscript.

The Authors offer a review centered on pancreas transplantation, focusing on type 2 diabetes patients.  They analyze many works and report all relevant data in terms of epidemiology, survival and weight change.  The manuscript is clear and the structure is well organized.  References are recent.  There are some self-citations, but I believe they can be justified by the strong experience of the authors in this field, since they contributed a lot.

The choice to offer many graphics is the real strength of the work, because it simplifies the reading and the understanding.

Nevertheless, I would like to clarify some points with the authors, to offer some suggestions and I hope they will apport some changes or (in alternative) express their point of view.

ABSTRACT – I believe that this section could be more schematic and less narrative.  For example, they could use the structure “background, materials and methods, etc” or summarize/reducing its length.  Not mandatory, just a suggestion to make the text slighter.

INTRODUCTION -  Line 64 “in 2014, 422 million”:  could you replace it with more recent data?  It is just a general epidemiology, I am sure you can find more update numbers.

Table 1-2:  actually they are not well identifiable.  They can be actually confused with the rest of the text.  Please change the layout.

GENERAL SUGGESTIONS – In many parts of the text the Authors emphasized the role of transplant on improving quality of life.  I think that a brief paragraph citing more relevant studies on quality of life after transplantation (or how to evaluate it) may play an interesting role in this work.  Could you provide?

METHODOLOGY – It is clear that this work is structured as a narrative review.  Nevertheless, I think that a “methods section” is mandatory.  In particular:  how did they select all of the cited works?  Which inclusion/exclusion criteria were used?  The question might be answered both in the Abstract (for example line 28:  this narrative review…) and in an appropriate paragraph.  Thank you Authors for your contribution.

Response:  Thank you for your insightful comments.  We have shortened that Abstract and have made it more structured.  In the Introduction, we have updated the global epidemiological diabetes data as per Reviewer’s 2 suggestion.  We agree that the Tables are hard to distinguish; we have changed the spacing and bolded the titles but otherwise defer to the journal editor to redesign accordingly.  Following Table 2 on page 17, the paragraph from line 647 to 658 discusses quality of life and includes 10 references cited.  We have added 2 paragraphs to highlight some of the quality of life findings associated with successful PTx.  We have added a Methods section to the Abstract and in the text (new section 2) following the Introduction.

We sincerely hope that these changes meet with your approval.  Thank you for your consideration. 

Sincerely,

 

 

Robert J. Stratta, MD

Professor of Surgery, Director of Transplantation

Wake Forest School of Medicine