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
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.
J Clin Med. 2022 Jun 24;11(13):3658. doi: 10.3390/jcm11133658.
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.
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.
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, = 0.0001). Comparative analysis did not significantly differ in the number of transplanted livers (cluster1/cluster2 94.1%/95.6% = 0.84) and the 30-day graft dysfunction rate (cluster1/cluster2 0.0%/4.8% = 0.34).
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.
在新冠疫情期间，患者集中化使得创伤和移植转诊中心能够继续其常规活动，确保了最佳的医疗服务可及性。本研究旨在分析意大利北部创伤的集中化与肝脏分配之间的联系。
根据创伤相关变量进行聚类分析以生成患者表型。对各聚类进行比较，以评估所实施的损伤控制策略程序（DCS）以及30天移植肝功能障碍方面的差异。
在疫情期间，严重创伤的集中化严重损害了米兰大都市区各移植中心之间的肝脏获取与分配（尼瓜尔达医院：22例肝脏获取；其他移植中心：2例器官获取）。在尼瓜尔达医院的系列病例中识别出两个聚类：聚类1由17名（27.4%）创伤供体组成，其中13名（76.5%）接受了DCS程序治疗，4名（23.5%）未接受；聚类2由45名创伤供体（72.6%）组成，其中22名（48.8%）接受了DCS程序。各聚类之间在实施DCS程序的数量上存在显著差异（3.18±2.255对1.11±1.05，P = 0.0001）。比较分析显示，移植肝脏数量（聚类1/聚类2，94.1%/95.6%，P = 0.84）和30天移植肝功能障碍率（聚类1/聚类2，0.0%/4.8%，P = 0.34）无显著差异。
一级创伤中心所提供的高水平医疗服务能够减少适合捐赠器官的损失，即使在多器官损伤的情况下，也能维持移植器官的良好预后。疫情期间凸显出严重创伤的集中化会损害移植中心之间的肝脏分配。
