Early U.S. Heart Transplant Experience With Normothermic Regional Perfusion Following Donation After Circulatory Death
Related Experiment Video
Updated: Jul 14, 2026
Lung Rapid Recovery Procurement Combined with Abdominal Normothermic Regional Perfusion in Controlled Donation after Circulatory Death
Published on: August 15, 2022
Abigail R Benkert1, Jeffrey E Keenan1, Jacob N Schroder1
1Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
Insights
Normothermic regional perfusion (NRP) for donation after circulatory death heart transplantation (DCD HT) shows better short-term survival than direct procurement and perfusion (DPP). This study highlights NRP as a promising DCD HT procurement method in the U.S.
Area of Science:
- Cardiology
- Transplant Surgery
- Organ Procurement
Background:
- Donation after circulatory death heart transplantation (DCD HT) offers outcomes comparable to donation after brain death, increasing transplant volumes.
- The U.S. experience with normothermic regional perfusion (NRP) for DCD HT procurement is not well-documented.
Purpose of the Study:
- To compare short-term outcomes of NRP versus direct procurement and perfusion (DPP) in DCD HT within the United States.
- To evaluate the effectiveness of different DCD HT procurement methods on patient survival.
Main Methods:
- Analysis of the United Network for Organ Sharing (UNOS) registry for adult DCD HT cases from January 2019 to December 2023.
- Stratification of transplantations based on NRP or DPP reperfusion methods.
- Primary outcome assessed was overall patient survival using Kaplan-Meier and propensity-matched analyses.
Main Results:
- A total of 918 DCD HT cases were included: 622 (68%) using DPP and 296 (32%) using NRP.
- Unadjusted survival analysis showed improved short-term survival with NRP (log-rank P = 0.005).
- Adjusted analysis revealed NRP was independently associated with improved survival (HR: 0.39; P = 0.002), confirmed by propensity-matched analysis (log-rank P = 0.006).
Conclusions:
- Normothermic regional perfusion (NRP) is associated with improved short-term survival compared to direct procurement and perfusion (DPP) in DCD HT.
- This study represents the largest U.S. series evaluating DCD HT procurement perfusion strategies.
- Further long-term follow-up is necessary to fully assess the impact of NRP and DPP on post-heart transplantation outcomes.
Background:
Heart transplantation following donation after circulatory death (DCD HT) has short-term survival outcomes comparable to donation after brain death and has led to a significant increase in transplantation volume. The U.S. experience with the normothermic regional perfusion (NRP) DCD HT procurement method has not been evaluated.
Objectives:
The aim of this study was to examine short-term outcomes associated with NRP vs direct procurement and perfusion (DPP) methods used during DCD HT in the United States.
Methods:
The UNOS (United Network for Organ Sharing) registry was queried for all adult (age ≥18 years) heart recipients and corresponding donors of controlled DCD HT from January 2019-December 2023. Transplantations were stratified by NRP or DPP reperfusion methods. The primary outcome was overall survival.
Results:
A total of 918 heart donors and recipients met inclusion criteria, including 622 (68%) DPP and 296 (32%) NRP transplantations. Unadjusted Kaplan-Meier survival analysis demonstrated improved short-term survival associated with NRP (log-rank P = 0.005). After adjustment, DCD HT with NRP was independently associated with improved survival (HR: 0.39 [95% CI: 0.22-0.70]; P = 0.002). A propensity-matched analysis similarly demonstrated a cumulative survival benefit to NRP (log-rank P = 0.006).
Conclusions:
In this largest national series of DCD HT procurement perfusion strategies, NRP is associated with improved short-term survival as compared with DPP. This study evaluates the U.S. early experience with DCD HT, and longer-term follow-up data are needed to further assess the impact of DPP and NRP methods on post-heart transplantation outcomes.
