Marginal versus Standard Donors in Heart Transplantation: Proper Selection Means Heart Transplant Benefit
, Raphael Caraffa 1,†, Massimiliano Carrozzini 2, Alvise Guariento 1, Jonida Bejko 3, Marny Fedrigo 1, Chiara Castellani 1, Giuseppe Toscano 1, Giulia Lorenzoni 1,4, Vincenzo Tarzia 1, Dario Gregori 1,4, Massimo Cardillo 5, Francesca Puoti 5, Giuseppe Feltrin 6, Annalisa Angelini 1,‡ and Gino Gerosa 1,‡
Round 1
Reviewer 1 Report
The authors compared the operative results of patients who had heart transplantations with marginal or standard donor hearts. They concluded that proper selection means heart transplant benefit.
I agree their conclusions including the expectation in possibility of OCS. However there are some questions as below.
- P7L101; MDs were defined with the following criteria; a. age over 60 years, b. reduced LV performance(EF 40-50%), c. LV hypertrophy(septal thickness>14mm),d. focal lesion of the coronary artery, e. significant valvular heart disease.; I could not find any details of the a-e groups. For proper selection of the donor, they should mention about at least number of a-d groups. If possible, they should comment which definition is most important for good selection.
- P11L171; At univariate analysis for follow-up mortality, higher preoperative bilirubin level (p=0.049): in which P number is different from P=0.08 in Table 4 , higher rate of CVVH(p=0.001): CVVH is not in Table 4 even it is listed in abbreviation of Table 4 (CVVH = renal replacement therapy (P<0.01))?, and cold ischemic time (of donor heart)(P=0.041) : in which P number is different from p=0.12 in Table 4.
Author Response
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Author Response File: 
Author Response.docx
Reviewer 2 Report
Abstract: the abstract is well written and provides all necessary informations.
Introduction: i would suggest to mention primary and secondary endpoints and the design of the study (retrospective observational) in the introduction.
M&M: I would suggest to move Table 1 to the Results- section. Additionally, I would recommend to mention the listing- system and its implications on urgency in the M&M- section, as not everybody knows the italian graduation. I find Table 1 hard to read- maybe you should divide it into baseline demographic informations and transplant- related informations, such as listing status, VAD, etc.
Please mention the technique used for HTx in your intstitution.
Results: Please use HR consistently.
Discussion: Please check the actual literature- there are some groups examining outcomes after HTx and MD (i.e., Thoracic Cardiovasc Surg . 2021 Sep;69(6):490-496., Clin Transpl 2020 Nov;34(11):e14057., J Card Surg, 2021 Dec;36(12):4828-4829.) and include these in the actual discussion.
Author Response
Please see the attachment.
Author Response File: Author Response.docx
Round 2
Reviewer 1 Report
I enjoyed this manuscript very much. The authors revised it according to the reviewers' comments well.
Only one spelling mistake;L322 : Sugimara →Sugimura
