Kidney Transplants Before and During the COVID-19 Pandemic at the University Hospital of Guadeloupe

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Overviev and Proposals in word document.

Comments for author File: Comments.pdf

Author Response

We would like to thank you for your thoughtful comments and for taking the time to review our manuscript in detail. We have considered your suggestions and made the necessary adjustments to the manuscript.

Thank you again for your constructive feedback.

Reviewer 2 Report

Comments and Suggestions for Authors

The authors conducted a retrospective study within their institution regarding kidney transplant outcomes before and during the COVID-19 pandemic. Due to the descriptive nature of this study, its novelty and contribution to the existing literature are limited. In addition, the literature review on COVID-19 is insufficient, as several pivotal studies were not included. Furthermore, the timing of many data points is vague, making it difficult to interpret the results accurately. I hope the following comments will help improve the quality of the manuscript.

Minor comments

1. The alignment and organization of the Methods section are disorganized and should be revised for clarity.

2. The authors should clearly indicate the beginning of the pandemic in their country. In fact, the onset of the pandemic varied between countries, typically starting around February 2020. This definition would significantly affect the grouping and interpretation of outcomes.

3. A ten-year study period is quite long. There may have been changes in post-transplant care, immunosuppressive regimens, and other management strategies during this time. Please describe any such evolutions, if applicable.

4. Baseline immunosuppressive regimens and desensitization protocols should be described in the Methods or Results section.

5. Listing blood types alone is not meaningful. Blood type is relevant mainly in cases of ABO-incompatible transplants. It is difficult to interpret such information from Table 2 as currently presented.

6. In Table 3, please clarify what “cardiac arrest” refers to. From Table 2, it appears that most donors were DBD (donation after brain death) donors, whose hearts would have been beating prior to cross-clamping.

7. In Section 3.4 and Figure 3, the analytical method used should be described in the Methods section in advance.

8. It is unclear why recipients from 2013–2019 are shown as having COVID-19. Please clarify the time point or definition used for complications in the table.

Author Response

 

1. Comment: The alignment and organization of the Methods section are disorganized and should be revised for clarity.
• Response: The Methods section has been reorganized according to the STROBE guidelines to enhance clarity and structure.
2. Comment: The authors should clearly indicate the beginning of the pandemic in their country. In fact, the onset of the pandemic varied between countries, typically starting around February 2020. This definition would significantly affect the grouping and interpretation of outcomes.
• Response: In alignment with mainland France, the pandemic was considered to have started on March 1, 2020. This has been clearly indicated in the manuscript.
3. Comment: A ten-year study period is quite long. There may have been changes in post-transplant care, immunosuppressive regimens, and other management strategies during this time. Please describe any such evolutions, if applicable.
• Response: No changes were made to immunosuppressive regimens or post-transplant care during the study period. This has been clarified in the revised manuscript.
4. Comment: Baseline immunosuppressive regimens and desensitization protocols should be described in the Methods or Results section.
• Response: The immunosuppressive regimens and desensitization protocols used at the CHU of Guadeloupe during the study period are outlined in Section 2.9 of the Methods.
5. Comment: Listing blood types alone is not meaningful. Blood type is relevant mainly in cases of ABO-incompatible transplants. It is difficult to interpret such information from Table 2 as currently presented.
• Response: We agree with the comment. Blood type information for donors has been removed from Table 2 as all transplants were ABO-compatible.
6. Comment: In Table 3, please clarify what “cardiac arrest” refers to. From Table 2, it appears that most donors were DBD (donation after brain death) donors, whose hearts would have been beating prior to cross-clamping.
• Response: The term “cardiac arrest” in Table 3 referred to ECD (Expanded Criteria Donor) donors, who were DBD (Donation after Brain Death). We have moved this information to Table 2 and removed the line from Table 3.
7. Comment: In Section 3.4 and Figure 3, the analytical method used should be described in the Methods section in advance.
• Response: The corresponding analytical methods have now been described in the Statistics section of the Methods.
8. Comment: It is unclear why recipients from 2013–2019 are shown as having COVID-19. Please clarify the time point or definition used for complications in the table.
• Response: We have replaced the periods with the terms Pre-COVID-RG (recipients transplanted before COVID-19) and COVID-RG (recipients transplanted during the pandemic). This clarifies that patients transplanted during the pandemic were vaccinated prior to transplant and therefore did not develop COVID-19 post-transplant.

Reviewer 3 Report

Comments and Suggestions for Authors

Congratulations to the colleagues for their hard work in keeping the kidney transplantation program in the country going successfully.

The work is intriguing due to its focus on transplantation information from Guadeloupe.  Clearly, a considerable amount of effort and attention to detail has gone into preparing and presenting this work. I really appreciate the research effort involved.

 

Please accept the following comments:

 

Comment 1:

It is to be advised that the terms

 

'Graft retrieval' or 'graft harvesting' will change to 'recovery of organs'.

'Deceased cardiac arrest' will change to 'donation after cardiac death'.

'Deceased brain-dead donor'' will change to ‘deceased donor'.

'Living-related donor' will change to 'living donor'.

These changes should be made throughout the manuscript.

Please change 'historical cohort (line 67) change' to 'retrospective cohort' because the former is used later in the text.

Please change Delayed recovery of graft function (Line 102) to delayed graft function

Comment 2:

Please include Information on the causes of kidney disease that lead to transplantation in the clinical profile of kidney transplant recipient.

Author Response

Comment 1:

Comment: It is advised that the terms "Graft retrieval" or "graft harvesting" be changed to "recovery of organs". "Deceased cardiac arrest" should be changed to "donation after cardiac death". "Deceased brain-dead donor" should be changed to “deceased donor". "Living-related donor" should be changed to "living donor". These changes should be made throughout the manuscript.

• • Response: We have made the following changes throughout the manuscript:
    • "Graft retrieval" or "graft harvesting" → "recovery of organs"
    • "Deceased cardiac arrest" → "donation after cardiac death"
    • "Deceased brain-dead donor" → "deceased donor"
    • "Living-related donor" → "living donor"

Comment: Please change "historical cohort" (line 67) to "retrospective cohort" because the former is used later in the text

• • Response: We have changed "historical cohort" to "retrospective cohort" for consistency.

Comment: Please change "Delayed recovery of graft function" (Line 102) to "delayed graft function".

• • Response: The term "Delayed recovery of graft function" has been changed to "delayed graft function".

Comment 2:

Comment: Please include information on the causes of kidney disease that lead to transplantation in the clinical profile of kidney transplant recipients.

• • Response: Information on the causes of kidney disease leading to transplantation has been added to Table 1 and the clinical profile of the recipients.

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

The authors addressed the necessary changes.