Transplant vs. Resection for Non-HCC Malignancies of the Liver

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Dear Authors,

You are addressing an interesting and evolving concept of oncological liver transplantation. I strongly believe that this field has a promising future. As you concluded, it is not about competing approaches but rather working simultaneously to achieve the best possible treatment for patients.

This is a nice review of a truly extensive topic. I do not have major comments, but perhaps you could include a table comparing different outcomes, as this would add to the paper’s outlook and readability.

Best wishes with your paper,
Kind regards

Author Response

Dear Authors,

You are addressing an interesting and evolving concept of oncological liver transplantation. I strongly believe that this field has a promising future. As you concluded, it is not about competing approaches but rather working simultaneously to achieve the best possible treatment for patients.

This is a nice review of a truly extensive topic. I do not have major comments, but perhaps you could include a table comparing different outcomes, as this would add to the paper’s outlook and readability.

Best wishes with your paper,
Kind regards

 

Response: 

We sincerely thank the reviewer for their positive and insightful comments regarding our manuscript and for recognizing the evolving importance of oncological liver transplantation. We fully agree that this field holds great promise and that transplantation and resection should be viewed as complementary approaches aimed at optimizing patient outcomes rather than competing strategies. In response to the reviewer’s helpful suggestion, we have added a table (Table 3) to the results summarizing and comparing the main outcomes of surgical resection and liver transplantation across non-HCC malignancies.

Reviewer 2 Report

Comments and Suggestions for Authors

This is a concise review describing in brief the outcomes for resection or transplantation for select Non HCC liver tumors or metastasis

Major comments: 

The various selection criteria and outcomes, especially for CLRM and NET need to be described  in detail.

Various clinical trials reported, being conducted or registered related to the above should be added.

The latest guidance for MELD exception has not been mentioned in the manuscript.

Discussion should include the possibility of offering transplant to borderline resectable cases who undergo PVE or ALPPS, especially in view of increasing organ availability with expanded use of DCD and extended  criteria donors with newer perfusion technologies.

Author Response

This is a concise review describing in brief the outcomes for resection or transplantation for select Non HCC liver tumors or metastasis

Major comments: 

The various selection criteria and outcomes, especially for CLRM and NET need to be described  in detail.

Various clinical trials reported, being conducted or registered related to the above should be added.

The latest guidance for MELD exception has not been mentioned in the manuscript.

Discussion should include the possibility of offering transplant to borderline resectable cases who undergo PVE or ALPPS, especially in view of increasing organ availability with expanded use of DCD and extended  criteria donors with newer perfusion technologies.

 

Response: We sincerely thank the reviewer for their insightful comments regarding our manuscript. We have already included the key landmark and latest trials pertaining Liver transplant. We have added the latest guidance for MELD exception and the paragraph on increasing organ availability.

Reviewer 3 Report

Comments and Suggestions for Authors

This is a comprehensive review on liver transplantation Vs. resection for non-HCC malignancies It cites previous reviews showing similar conclusions. I would expect the authors to add future directions using new molecular/ genetic markers or other tools to better select the appropriate candidates for transplant. Another option is to run a meta-analysis using previous studies resected or transplanted for non-HCC malignancies to strengthen the statistical model.

Author Response

This is a comprehensive review on liver transplantation Vs. resection for non-HCC malignancies It cites previous reviews showing similar conclusions. I would expect the authors to add future directions using new molecular/ genetic markers or other tools to better select the appropriate candidates for transplant. Another option is to run a meta-analysis using previous studies resected or transplanted for non-HCC malignancies to strengthen the statistical model.

Response: 

Thank you for your insightful comments. We have included potential future research directions. However, performing a meta-analysis is beyond the scope of this paper. Our review was designed as a narrative synthesis rather than a systematic review, and the available studies are highly heterogeneous in design, endpoints, and patient populations.

Reviewer 4 Report

Comments and Suggestions for Authors

The discussion between LT and liver surgery for metastatic disease is always of interest. The manuscript is well constructed and structured

Some minor changes

Table of MESH terms in CRC has a time frame of 2025-2025 - isn't 2005-25?

Do a minor review of some errors: example "acheive" on line 352

Abstract should be reduced to 200 words 

 

Author Response

The discussion between LT and liver surgery for metastatic disease is always of interest. The manuscript is well constructed and structured

Some minor changes

Table of MESH terms in CRC has a time frame of 2025-2025 - isn't 2005-25?

Do a minor review of some errors: example "acheive" on line 352

Abstract should be reduced to 200 words 

 

Response: 

We thank the reviewer for their thoughtful comments and positive feedback on our manuscript. We have addressed all suggested revisions.

Reviewer 5 Report

Comments and Suggestions for Authors

The problem with a limited type of review type of manuscript such as this one is that one is very much an overview of summary type of information/UNOS guidelines which appears to be directed at a US audience.

Plus there are a number of recently published review type manuscripts which will have an appeal to a wider audience.

Author Response

The problem with a limited type of review type of manuscript such as this one is that one is very much an overview of summary type of information/UNOS guidelines which appears to be directed at a US audience.

Plus there are a number of recently published review type manuscripts which will have an appeal to a wider audience.

 

Response: 

We thank the reviewer for their thoughtful comments. We would like to reiterate that apart from UNOS, we have also highlighted the OSLO and Milan score which aren’t from the US. We have also highlighted the trials from SECA which again aren’t from the United States. Our aim is to solely provide data from the literature and discuss insights of how these tumors are being weighted in terms of either a resection or transplant point of view. The recently published review type manuscripts either focus on one treatment outcome or a disease pathology but don’t cover the comprehensive extent of how we have done in our manuscript. We strongly believe this review would invite more people to make a comprehensive review of this debatable landscape and expand from there.

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

The revised version has adequately addressed the reviewer's suggestions.

Reviewer 5 Report

Comments and Suggestions for Authors

Note has been made of the modifications that have been made to the manuscript