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Centralization of Major Trauma Influences Liver Availability for Transplantation in Northern Italy: Lesson Learned from COVID-19 Pandemic

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 Norther...

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Autores principales: Altomare, Michele, Chierici, Andrea, Virdis, Francesco, Spota, Andrea, Cioffi, Stefano Piero Bernardo, Bekhor, Shir Sara, Del Prete, Luca, Reitano, Elisa, Sacchi, Marco, Ambrogi, Federico, Chiara, Osvaldo, Cimbanassi, Stefania
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9267522/
https://www.ncbi.nlm.nih.gov/pubmed/35806948
http://dx.doi.org/10.3390/jcm11133658
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author Altomare, Michele
Chierici, Andrea
Virdis, Francesco
Spota, Andrea
Cioffi, Stefano Piero Bernardo
Bekhor, Shir Sara
Del Prete, Luca
Reitano, Elisa
Sacchi, Marco
Ambrogi, Federico
Chiara, Osvaldo
Cimbanassi, Stefania
author_facet Altomare, Michele
Chierici, Andrea
Virdis, Francesco
Spota, Andrea
Cioffi, Stefano Piero Bernardo
Bekhor, Shir Sara
Del Prete, Luca
Reitano, Elisa
Sacchi, Marco
Ambrogi, Federico
Chiara, Osvaldo
Cimbanassi, Stefania
author_sort Altomare, Michele
collection PubMed
description 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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spelling pubmed-92675222022-07-09 Centralization of Major Trauma Influences Liver Availability for Transplantation in Northern Italy: Lesson Learned from COVID-19 Pandemic Altomare, Michele Chierici, Andrea Virdis, Francesco Spota, Andrea Cioffi, Stefano Piero Bernardo Bekhor, Shir Sara Del Prete, Luca Reitano, Elisa Sacchi, Marco Ambrogi, Federico Chiara, Osvaldo Cimbanassi, Stefania J Clin Med Article 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. MDPI 2022-06-24 /pmc/articles/PMC9267522/ /pubmed/35806948 http://dx.doi.org/10.3390/jcm11133658 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Altomare, Michele
Chierici, Andrea
Virdis, Francesco
Spota, Andrea
Cioffi, Stefano Piero Bernardo
Bekhor, Shir Sara
Del Prete, Luca
Reitano, Elisa
Sacchi, Marco
Ambrogi, Federico
Chiara, Osvaldo
Cimbanassi, Stefania
Centralization of Major Trauma Influences Liver Availability for Transplantation in Northern Italy: Lesson Learned from COVID-19 Pandemic
title Centralization of Major Trauma Influences Liver Availability for Transplantation in Northern Italy: Lesson Learned from COVID-19 Pandemic
title_full Centralization of Major Trauma Influences Liver Availability for Transplantation in Northern Italy: Lesson Learned from COVID-19 Pandemic
title_fullStr Centralization of Major Trauma Influences Liver Availability for Transplantation in Northern Italy: Lesson Learned from COVID-19 Pandemic
title_full_unstemmed Centralization of Major Trauma Influences Liver Availability for Transplantation in Northern Italy: Lesson Learned from COVID-19 Pandemic
title_short Centralization of Major Trauma Influences Liver Availability for Transplantation in Northern Italy: Lesson Learned from COVID-19 Pandemic
title_sort centralization of major trauma influences liver availability for transplantation in northern italy: lesson learned from covid-19 pandemic
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9267522/
https://www.ncbi.nlm.nih.gov/pubmed/35806948
http://dx.doi.org/10.3390/jcm11133658
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