Post-transplant survival after normothermic regional perfusion versus direct procurement and perfusion in donation...

Area of Science:

• Cardiology
• Transplantation Surgery
• Organ Donation

Background:

• The use of hearts from donors after circulatory death (DCD) for transplantation has risen since 2019.
• Direct Procurement and Perfusion (DPP) and Normothermic Regional Perfusion (NRP) are the primary DCD heart procurement methods.
• No prior comparisons of post-transplant survival between DPP and NRP techniques exist.

Purpose of the Study:

• To compare the 1-year post-transplant survival rates of heart recipients based on procurement technique (DPP vs. NRP) in donors after circulatory death.

Main Methods:

• An observational study analyzed adult DCD heart transplants from January 2019 to December 2021 using the Scientific Registry of Transplant Recipients.
• Propensity-score matching was employed to create comparable groups of transplants procured via DPP and NRP.
• Kaplan-Meier and Cox proportional hazards models were used to assess the association between procurement technique and 1-year survival.

Main Results:

• The study included 318 DCD heart transplants: 216 (68%) by DPP and 102 (32%) by NRP.
• After propensity-score matching, 1-year post-transplant survival was similar between the two techniques (93.1% for NRP vs. 91.1% for DPP, p=0.79).

Conclusions:

• Both NRP and DPP procurement methods are associated with comparable 1-year survival rates for DCD heart recipients.
• NRP could be considered the preferred procurement technique for DCD hearts, contingent on ethical permissibility and demonstrated benefits in abdominal organ transplantation.