Related Experiment Video
Updated: Jun 8, 2025
Lung Rapid Recovery Procurement Combined with Abdominal Normothermic Regional Perfusion in Controlled Donation after Circulatory Death
Published on: August 15, 2022
Direct procurement with machine perfusion and normothermic regional perfusion in donation after circulatory death
Matthew L Goodwin1, Ian C Nickel1, Hui Li1
1Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health and School of Medicine, Salt Lake City, Utah.
Insights
Donation after circulatory death (DCD) heart transplants show similar survival to donation after brain death (DBD) donors. However, DCD recipients experienced more acute rejection, though outcomes with direct procurement with machine perfusion (DPP) and thoracoabdominal normothermic regional perfusion (TA-NRP) were comparable.
Area of Science:
- Cardiovascular Surgery
- Transplantation Medicine
- Organ Donation
Background:
- Donation after circulatory death (DCD) heart transplants are increasing, utilizing direct procurement with machine perfusion (DPP) and thoracoabdominal normothermic regional perfusion (TA-NRP) techniques.
- Limited data exist on the comparative outcomes of DPP and TA-NRP in DCD heart transplantation.
- This study compares post-transplant outcomes of DCD heart donors with donation after brain death (DBD) donors.
Purpose of the Study:
- To investigate the impact of DCD donor technique on heart transplant outcomes.
- To compare post-transplant survival and complications between DCD and DBD heart recipients.
- To evaluate the outcomes of DPP versus TA-NRP perfusion techniques in DCD heart transplantation.
Main Methods:
- Analysis of adult heart transplant recipients from the United Network for Organ Sharing registry (December 2019–June 2023).
- Identification of DPP and TA-NRP groups based on specific perfusion criteria.
- Propensity score matching (1:3 ratio) and statistical comparison of survival and rejection rates between DCD and DBD cohorts.
Main Results:
- No significant difference in 1-year survival between DCD and DBD heart recipients in matched and unmatched cohorts.
- DCD recipients showed increased rates of acute rejection (treated and untreated) compared to DBD recipients.
- One-year survival and post-transplant outcomes were similar between DPP and TA-NRP groups, despite increased functional warm ischemia time (fWIT) in TA-NRP.
Conclusions:
- DCD heart recipients experience higher rates of acute rejection compared to DBD recipients.
- Despite technique variations and potential differences in functional warm ischemia time, direct procurement with machine perfusion and thoracoabdominal normothermic regional perfusion demonstrate comparable outcomes in DCD heart transplantation.
- Overall survival and secondary outcomes are similar between DCD and DBD heart transplant recipients.
Background:
Donation after circulatory death (DCD) heart transplants have increased in the United States with direct procurement with machine perfusion (DPP) and thoracoabdominal normothermic regional perfusion (TA-NRP) techniques. There remains a paucity of data examining DPP and TA-NRP outcomes. The purpose of this study was to investigate the impact of the DCD technique on post-transplant outcomes compared to donation after brain death (DBD) donors.
Methods:
Adult patients undergoing heart transplantation between December 1, 2019, and June 30, 2023, were identified in the United Network for Organ Sharing registry. DPP and TA-NRP groups were identified using time of death to an aortic cross-clamp time of 30 minutes. Categorical variables were compared using the χ2 or Fisher exact test, and continuous variables were compared using the Mann-Whitney U test. Propensity score matching was performed using a 1:3 match. One-year survival was analyzed using the log-rank test and a Cox proportional hazard regression model.
Results:
During the study period, there were 7338 DBD and 419 DCD heart transplants. At 1 year post-transplant, there was no difference in survival between unmatched (P = .13) and matched (P = .36) DBD and DCD heart recipients. There was an increase in acute rejection and rejection requiring treatment in DCD recipients compared to DBD recipients in the matched cohort. A total of 134 TA-NRP transplants and 242 DPP transplants were performed. One-year survival and post-transplant outcomes were similar in the DPP and TA-NRP groups. TA-NRP functional warm ischemia time (fWIT) was increased significantly during the study period.
Conclusions:
In this matched cohort, DCD heart recipients experienced increased acute rejection, both treated and nontreated, compared to DBD heart recipients. Despite differences in the techniques and likely in fWIT, acute rejection, survival, and other secondary outcomes are similar with DPP and TA-NRP.
