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

Round 1

Reviewer 1 Report

Altomare  et  al.  aimed  to analyze how the centralization of trauma is linked with the 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. According  to  the study a significant difference was found in the number of DCS procedures performed between clusters ().They  concluded  as the high level of care guaranteed by first-level trauma centers could reduce the loss of organs suitable for donation, maintaining the good final outcomes of transplanted ones, even in case of multiple organ injury. They  reported as the pandemic period underlined that the centralization of major trauma impairs the liver allocation between transplant centers.The  idea  is  smart. Some minor  issues raised;

1-Page 9, line 274, please  delete  point  before  sentence.

2-There  are  some  similar (not the  same)  studies in the  current  medical  literature

For example:Changes in the Deceased-Donor Trend in Korea: Establishment of Regional Trauma Centers and KODA.Lee JM.J Clin Med. 2022 Feb 24;11(5):1239. doi: 10.3390/jcm11051239.

Would  you  like  to  discuss  these studies?

3-Please  add  a  limitation  paragraph  before  the conclusion. So,  we  can  see  the  strengths  and  weakness  of  the  study.

Thank  you  giving opportunity  to  review  this  study.

Author Response

We would also like to thank the Reviewers for their valid and accurate suggestions, which helped us improve the general quality of the description. According to the Reviewer's requests, we made the following adjustments to the revised version R1 of our article.

Reviewer 1:

• Page 9, line 274, please delete the point before the sentence.

We have deleted the point before the paragraph.

1.2 There are some similar (not the same)  studies in the current medical literature. For example, Changes in the Deceased-Donor Trend in Korea: Establishment of Regional Trauma Centers and KODA.Lee JM.J Clin Med. 2022 Feb 24;11(5):1239. DOI: 10.3390/jcm11051239.

Would you like to discuss these studies?

We really would like to thank reviewer 1 for the suggested reading. The article from Lee et al. analyzes how the trend of deceased-donor recruitment and donation has changed in South Korea based on policy factors such as independent organ-procurement organization (IOPO) activities and establishing regional trauma centers. Despite the similarity of the contents in the two articles, there are profound differences between each country regarding the organs allocation, and comparing the population could be misleading. We are planning to build a national trauma donors registry to study this population's Italian epidemiology, and we could utilize the suggested article in the following paper.

• Please add a limitation paragraph before the conclusion. So,  we can see the strengths and weaknesses of the study.

As requested, this R1 enclosed version adds a new limitation paragraph (line 307-313) before the conclusion.

To satisfy the minor English revisions requested from Reviewer 2 and Reviewer 3, thanks to a mother tongue colleague, we also extensively edited the English language and style.

We declare that the article is original and was never presented and/or submitted elsewhere, and all Authors approve the revised version.

We hope that the enclosed amended R1 version of the present submission will be judged of sufficient quality for being accepted for publication in JCM.

We remain at your disposal if any question or request may arise.

Respectfully yours,

Michele Altomare, MD

Sapienza University of Rome, Rome (Italy)

[email protected]

Reviewer 2 Report

Dear authors

Congratulations on writing this interesting paper. The actual impact of COVID outbreak on organ transplantation has been seen across the board and the system adopted to allocate severe trauma to specialised centres address the point of saving potential organ donors.

Some minor spelling checks and typos only.

Regards 

Author Response

Please see the file attached. 

Author Response File: Author Response.docx

Reviewer 3 Report

Thank you for addressing the minor concerns. Congratulations on a good paper

Author Response

Please see the file attached. 

Author Response File: Author Response.docx

This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.

Round 1

Reviewer 1 Report

Congratulations on a high percentage of successful transplants from a sick  population of DBD trauma donors. Centralization of trauma referral and aggressive management of sick (Cluster 1) patients with DCS procedures has resulted in outcomes comparable to slightly less sicker (Cluster 2) patients

For the benefit, interest of readers could you describe in a little more detail how these Clusters were derived. 

In the discussion the difference in the type of DCS procedures performed between the two Clusters could be highlighted 

Minor points

In the abstract should the 30 day graft dysfunction rate be 0. 4.8 %

Are references 3 and 4 the same?