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Altomare M, Chierici A, Virdis F, Spota A, Cioffi SPB, Bekhor SS, Del Prete L, Reitano E, Sacchi M, Ambrogi F, Chiara O, Cimbanassi S. Centralization of Major Trauma Influences Liver Availability for Transplantation in Northern Italy: Lesson Learned from COVID-19 Pandemic. J Clin Med 2022; 11:jcm11133658. [PMID: 35806948 PMCID: PMC9267522 DOI: 10.3390/jcm11133658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 06/17/2022] [Accepted: 06/19/2022] [Indexed: 02/01/2023] Open
Abstract
Background: During the COVID-19 pandemic, the centralization of patients allowed trauma and transplants referral centers to continue their routine activity, ensuring the best access to health care. This study aims to analyze how the centralization of trauma is linked with liver allocation in Northern Italy. Methods: Cluster analysis was performed to generate patient phenotype according to trauma-related variables. Comparison between clusters was performed to evaluate differences in damage control strategy procedures (DCS) performed and the 30-day graft dysfunction. Results: During the pandemic period, the centralization of major trauma has deeply impaired the liver procurement and allocation between the transplant centers in the metropolitan area of Milan (Niguarda: 22 liver procurement; other transplant centers: 2 organ procurement). Two clusters were identified the in Niguarda’s series: cluster 1 is represented by 17 (27.4%) trauma donors, of which 13 (76.5%) were treated with DCS procedures, and 4 (23.5%) did not; cluster 2 is represented by 45 trauma donors (72.6%), of which 22 (48.8%) underwent DCS procedures. A significant difference was found in the number of DCS procedures performed between clusters (3.18 ± 2.255 vs. 1.11 ± 1.05, p = 0.0001). Comparative analysis did not significantly differ in the number of transplanted livers (cluster1/cluster2 94.1%/95.6% p = 0.84) and the 30-day graft dysfunction rate (cluster1/cluster2 0.0%/4.8% p = 0.34). Conclusions: The high level of care guaranteed by first-level trauma centers could reduce the loss of organs suitable for donation, maintaining the good outcomes of transplanted ones, even in case of multiple organ injuries. The pandemic period underlined that the centralization of major trauma impairs the liver allocation between transplant centers.
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Affiliation(s)
- Michele Altomare
- Department of Surgical Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
- General Surgery and Trauma Team, ASST Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; (F.V.); (A.S.); (S.P.B.C.); (S.S.B.); (O.C.); (S.C.)
- Correspondence: or
| | - Andrea Chierici
- Centre Hospitalier d’Antibes Juan-les-Pins–Chirugie Digestive, Department of General and Emergency Surgery, 06600 Antibes, France;
| | - Francesco Virdis
- General Surgery and Trauma Team, ASST Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; (F.V.); (A.S.); (S.P.B.C.); (S.S.B.); (O.C.); (S.C.)
| | - Andrea Spota
- General Surgery and Trauma Team, ASST Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; (F.V.); (A.S.); (S.P.B.C.); (S.S.B.); (O.C.); (S.C.)
| | - Stefano Piero Bernardo Cioffi
- General Surgery and Trauma Team, ASST Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; (F.V.); (A.S.); (S.P.B.C.); (S.S.B.); (O.C.); (S.C.)
| | - Shir Sara Bekhor
- General Surgery and Trauma Team, ASST Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; (F.V.); (A.S.); (S.P.B.C.); (S.S.B.); (O.C.); (S.C.)
| | - Luca Del Prete
- General and Liver Transplant Surgery Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Elisa Reitano
- General and Emergency Surgery, Ospedale Maggiore Della Carità di Novara, 28100 Novara, Italy;
| | - Marco Sacchi
- Department Emergenza Urgenza-E.A.S. SOREU Metropolitana, 20161 Milan, Italy;
| | - Federico Ambrogi
- Department of Clinical Science and Community Health, University of Milan, Festa del Perdono 7, 20122 Milan, Italy;
| | - Osvaldo Chiara
- General Surgery and Trauma Team, ASST Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; (F.V.); (A.S.); (S.P.B.C.); (S.S.B.); (O.C.); (S.C.)
- Department of Medical-Surgical Physiopathology and Transplantation, University of Milan, Festa del Perdono 7, 20122 Milan, Italy
| | - Stefania Cimbanassi
- General Surgery and Trauma Team, ASST Niguarda, Milano, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; (F.V.); (A.S.); (S.P.B.C.); (S.S.B.); (O.C.); (S.C.)
- Department of Medical-Surgical Physiopathology and Transplantation, University of Milan, Festa del Perdono 7, 20122 Milan, Italy
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