PONE-D-23-05474The weekend effect in kidney transplantation outcomes: a meta-analysisPLOS ONE

Dear Dr. Huang,

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Robert Jeenchen Chen, MD, MPH

Academic Editor

PLOS ONE

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3. We noticed you have some minor occurrence of overlapping text with the following previous publication(s), which needs to be addressed:

- https://doi.org/10.1371/journal.pone.0190227

- 10.1097/TP.0000000000001522

- https://doi.org/10.1111/tri.13377

In your revision ensure you cite all your sources (including your own works), and quote or rephrase any duplicated text outside the methods section. Further consideration is dependent on these concerns being addressed.

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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: Partly

Reviewer #2: Yes

Reviewer #3: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: I Don't Know

Reviewer #3: Yes

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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: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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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: No

Reviewer #2: Yes

Reviewer #3: Yes

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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 idea of this research was to define, whether there is any impact of week-end related kidney transplantation on the long-term outcomes. Some studies, in which the information of the timing of surgery was included – have been used for meta-analysis. The final conclusion is that there is no difference in graft survival, nevertheless when a procedure was performed. The data used for meta-analysis come from different European countries, USA and Australia-Zew Zealand.

The final result is not surprising, as all transplantation-related procedures, including matching, allocation, scores promoting special subgroups of patients, immunosuppression protocols, early post-op care - are standardized for years and nevertheless some minor site or country) - related disparities, are the same on week-end and during other days. The decision making algorithms are clear and are always consulted by phone (if necessary) with senior attending physicians in individual cases of trouble or any uncertainty.

The only factor which might be of interest is the experience of transplant surgeons, operating during week-ends, in a surgical technique of kidney transplantation and impact of this on the early surgical complications (and in longer perspective) – on graft outcome (driven by surgical problems). Again, nevertheless there are different systems of being on service in different transplant centers, always there is some system of duty-on-call, allowing to coordinate the presence of licensed transplant surgeon during week-ends, to perform the procedure.

This meta-analysis, as a medical research manuscript - is simplified, and the discussion touches just a top of a hidden iceberg. The quality therefore is limited, nevertheless a statistical/methodological workload, partially provided by a contemporary artificial intelligence. The discussion must be extended, describe at least the meaning of early surgical complication on early vs late graft function and survival in details. I am not sure, the authors are the transplant physicians and whether the feel all specific clinical aspects of this problem,

Reviewer #2: This is a well written meta-analysis which answers a relevant clinical question and the results is reassuring for patients and physicians.

Very well written introduction, and reasonable discussion. Congratulations to Authors!

My point which you may use in this manuscript is about the limitation of access to the OR in some health care systems. This issue usually ends to starting the harvest after regular OR time during the day to be able to accommodate high surgical volume. This usually results in starting the recipient after midnight. Despite that in some health care systems, there might be an increase in surgical fee if the case starts after midnight, the surgeons are really tired at the time of the surgery. This may have something to do with the better results on weekend when the surgery starts during the day time and may be the reason for having overall the same outcome.

You are welcome to use my point.

Reviewer #3: The manuscript is now much improved. Only suggestion is that in the discussion the authors mention that kidney transplantation is an emergency operation which is not factually correct since one can survive on dialysis. I think what the authors are trying to say is that there is a narrow window of time between organ harvesting to organ transplantation to maintain organ viability.

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Reviewer #1: No

Reviewer #2: Yes: Hamidreza Abdi

Reviewer #3: Yes: Anirban Ganguli

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The weekend effect in kidney transplantation outcomes: a meta-analysis

PONE-D-23-05474R1

Dear Dr. Huang,

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.

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If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. 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.

Kind regards,

Robert Jeenchen Chen, MD, MPH

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. 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 #2: All comments have been addressed

Reviewer #3: All comments have been addressed

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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 #2: Yes

Reviewer #3: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #2: I Don't Know

Reviewer #3: Yes

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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 #2: Yes

Reviewer #3: Yes

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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 #2: Yes

Reviewer #3: Yes

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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 #2: The revision looks better. There are many confounding factors for making a conclusion based on this work, however, this may be considered as a signal to do more work in future.

Reviewer #3: I would appreciate if-as a response to the query made not only by me or the other reviewers who perused the manuscript-the authors make it explicitly clear if the changes suggested have been incorporated. As I compare the original and the revised manuscript, the authors did change the wordings, copied and pasted the sentences into the response to reviewer without acknowledging the same.

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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 #2: Yes: Hamidreza Abdi

Reviewer #3: No

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