Stress burden related to postreperfusion syndrome may aggravate hyperglycemia with insulin resistance during living donor liver transplantation: A propensity score-matching analysis

Sumin Chae; Junghee Choi; Sujin Lim; Ho Joong Choi; Jaesik Park; Sang Hyun Hong; Chul Soo Park; Jong Ho Choi; Min Suk Chae

doi:10.1371/journal.pone.0243873

Peer Review History

Original SubmissionSeptember 19, 2020
28 Oct 2020 Decision Letter - Robert Jeenchen Chen, Editor PONE-D-20-29605 Stress burden related to postreperfusion syndrome may aggravate hyperglycemia with insulin resistance during living donor liver transplantation: a propensity score-matching analysis PLOS ONE Dear Dr. Chae, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please revise accordingly. Please submit your revised manuscript by Dec 12 2020 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. 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Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: No Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The authors revealed the findings that post-reperfusion syndrome could have an pivotal role in glucose homeostasis during operation but improved 7 days after transplant. Major concerns. 1. please provide the data of relationship between post-reperfusion syndrome and long-term denovo DM and infection to show clinical significant impact. 2.From pre-operative demographics, please analyse the risk factors, which will predict the occurrence of post-reperfusion syndrome Reviewer #2: Dear authors, thanks for the opportunity to review your article. In general, the study could be comprehensive and interesting for readers. There is only one comment to the authors: << As known, hepatitis C virus cold be related to type 2 DM. I suggest that the authors should analyze underlying liver disorders, such as alcoholic or hepatitis C /B liver diseases. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0243873.r001
Revision 1
18 Nov 2020 Author Response Point-by-point response letter Robert Jeenchen Chen, MD, MPH Academic Editor PLoS ONE Dear Dr. Chen, We thank you for the opportunity to revise our manuscript (PONE-D-20-29605) for publication in PLoS ONE. We also thank the reviewers for their insightful comments, which have helped us to considerably improve our manuscript. Our point-by-point responses to the reviewers’ comments are presented below, along with our revisions and the revised manuscript. The authors have no conflicts of interest to declare, and no funding was provided for this work. The authors confirm that neither the manuscript nor any part of its contents is currently under consideration by, nor has been published in, any other journal. The English in this document has been checked by at least two professional editors, both native speakers of English. For a certificate, please see: http://www.textcheck.com/certificate/I2Wujv Reviewer #1: The authors revealed the findings that post-reperfusion syndrome could have an pivotal role in glucose homeostasis during operation but improved 7 days after transplant. Major concerns. 1. please provide the data of relationship between post-reperfusion syndrome and long-term denovo DM and infection to show clinical significant impact. Response: As the reviewer suggested, we compared the rate of development of new-onset diabetes mellitus during the follow-up period, and that of early bacteremia during the first 4 postoperative weeks, between PS-matched patients with and without PRS. Although statistical significance was not attained, new-onset diabetes mellitus and early bacteremia were more frequent in the PRS than the non-PRS group (Table S3). We have added information on new-onset DM and early bacteremia to the “Patients and Methods” section (subheading: “Perioperative recipient and donor-graft findings”; pages 10 and 11) and the “Results” section (subheading: “Comparison of other outcomes in PS-matched patients with and without PRS”; page 23). 2. From pre-operative demographics, please analyse the risk factors, which will predict the occurrence of post-reperfusion syndrome Response: As the reviewer suggested, we analyzed the associations between demographic factors and the postreperfusion syndrome rate in the entire study population (n = 324) using univariate and multivariate logistic regression, as described in the “Statistical analysis” section (page 11) and the “Results” section (subheading: “Demographic characteristics of patients undergoing LDLT”; pages 12 and 13). In the univariate logistic regression, the psoas muscle index, MELD score, hepatocellular carcinoma status, ascites volume ≥ 1 L, diastolic dysfunction, hematocrit, platelet and lymphocyte counts, and albumin, total bilirubin, neutrophil and creatinine levels were associated with the development of postreperfusion syndrome (p≤0.1). In multivariate logistic regression, a higher MELD score, history of an ascites volume ≥ 1 L, and normal or grade I diastolic function were independently associated with the development of postreperfusion syndrome (Table S1; page 12). However, the association with diastolic dysfunction should be interpreted cautiously because clinical diastology (performed as suggested by the 2016 ASE/EACVI recommendations in patients who had undergone LDLT) reduced the prevalence of overt diastolic dysfunction and increased that of normal diastolic function (see “Perioperative recipient and donor-graft findings” on page 9). Among the patients with diastolic dysfunction (grade II–III), all those with PRS were grade III dysfunction and all those without PRS were grade II dysfunction (Table S2; pages 12 and 13). Reviewer #2: Dear authors, thanks for the opportunity to review your article. In general, the study could be comprehensive and interesting for readers. There is only one comment to the authors: << As known, hepatitis C virus cold be related to type 2 DM. I suggest that the authors should analyze underlying liver disorders, such as alcoholic or hepatitis C /B liver diseases. Response: As the reviewer suggested, we tested for an association between disease etiology and pre-transplant, new-onset diabetes mellitus in PS-matched patients (Table S4; page 23); the results are provided in the “Results” section (“Comparison of other outcomes in PS-matched patients with or without PRS” subsection; page 23). In patients with pre-transplant DM (n = 59), the most common etiology was alcoholic hepatitis (42.4%), while in post-transplant new-onset DM patients (n = 38) it was hepatitis B infection (44.7%). These findings may be caused by that hepatitis B is more common cause of end-stage liver disease, that subsequently lead to LDLT in Asian community, rather than hepatitis C (DOI: 10.1002/hep.27969). We believe that our manuscript has been greatly improved as a result of the revision process. We hope that the revised manuscript is now suitable for publication in PLoS ONE. Yours sincerely, Min Suk Chae, MD, PhD Attachments Attachment Submitted filename: Point by point response Letter.docx https://doi.org/10.1371/journal.pone.0243873.r002
30 Nov 2020 Decision Letter - Robert Jeenchen Chen, Editor Stress burden related to postreperfusion syndrome may aggravate hyperglycemia with insulin resistance during living donor liver transplantation: a propensity score-matching analysis PONE-D-20-29605R1 Dear Dr. Chae, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. 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If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed Reviewer #2: All comments have been addressed Reviewer #3: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: No ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: All the questions were addressed and the study provided the evidence for further investigation for post-transplant hypoperfusion syndrome. Reviewer #2: The authors had completely answered my question. I do not have any more question in the concerns about research ethics, or publication ethics . Reviewer #3: (No Response) ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No Reviewer #3: No https://doi.org/10.1371/journal.pone.0243873.r003
Formally Accepted
2 Dec 2020 Acceptance Letter - Robert Jeenchen Chen, Editor PONE-D-20-29605R1 Stress burden related to postreperfusion syndrome may aggravate hyperglycemia with insulin resistance during living donor liver transplantation: a propensity score-matching analysis Dear Dr. Chae: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Robert Jeenchen Chen Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0243873.r004

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